FUE vs FUT. Why do people prefer FUE over FUT more and more?

[FUE2014]

FUE and FUT scars comparable at grade 2? I think that's being very generous towards FUT!

[KO]

Interesting point about telogen hairs being wasted by FUT....never thought about that.

[1978matt]

Interesting point about telogen hairs being wasted by FUT....never thought about that.

 

It is equally possible to kill telogen hairs with FUE. You see what you think are 2 follicles (hairs) close together, punch around it severing the third follicle which happened to be missing hair.

 

Even using the direction of hair growth as a guide it can be complete guess work as to the path the follicle takes below the skin surface.

 

The best FUE surgeons can easily kill 10% of extracted follicles which is more or less on a par with the percentage in the resting phase.

[1978matt]

It's really sad that the 'experts' told you either technique prevents you from shaving, but FUT stayed in business along time because of that assumption.

Disclaimer - if you have a certain type of skin it may be harder.

 

 

I don't see your point. We have already seen some not-so-good FUE scarring just as we have seen not-so-good strips. A doctor would be expected to advise the possibility that you won't be able to shave to a grade 0.

 

 

Some other points I read on this thread.

1) FUT will have a renaissance.

Totally disagree. Why would it? Education is improving and patients are demanding FUE. Strip will continue to go down in importance in countries with a mature HT industry unless ignorance really gets a shot in the arm. Possibly countries new to HT will boost it, but no renaissance. Makes no sense.

 

 

Of course you're entitled to your opinion but I disagree with your disagreement!

 

There will be a lot of poor FUE work from inexperienced and untrained doctors jumping on the bandwagon. If the patients aren't too thinned out the chances are their only option will be repair work via strip.

 

In 10 years time the people who had extractions well outside the strip safe zone will start going bald again and wondering why the dot scars are becoming exposed in their crown area. This will only serve to make people think twice about the potential pitfalls of relying solely on FUE transplants, especially if they progress beyond a norwood 5.

 

...and as has been stated time and time again, for the most part the average guy will get the most hair, least DHT sensitive and most consistent results by taking an FUT approach.

 

 

2) If you talke a strip and re-close it you are STRETCHING the scalp hence THINNING the remaining hair. Image stretching your front lawn without adding any grass.

 

I never heard of anyone on any forum stating this as a problem. I mean, the difference might mean your hair going from lets say 180 to 140 hairs/cm2. Completely imperceptible unless someone already had thin hair - in which case I would question why he got any surgery in the first place.

 

Furthermore, a 5000 strip will take 300-500 telogen (resting phase hairs within the strip which are invisible) so really its a 5400 strip 'cept you get 5000 . FUE does not touch telogen hairs unless they are within an otherwise growing follicle and even then, they should survive as part of the bundle.

 

As mentioned in my previous reply you are equally likely to kill resting follicles with FUE. In fact, I did see a top FUE doctor list the numbers of follicles he damaged during extraction. It was about 900 out of 8000 on one patient.

Edited September 24, 2014 by 1978matt

[Rootz]

The example I posted also wasn't shaved down to the skin. I mean literally, bic razor shaved down to the skin. Like the front of your face when you shave (ie. the type of haircut one would get when your hair loss progresses and you run out of transplant reserve). Show me that you can't see tiny circular scars all over the scalp.

 

I don't have a good example of that, I doubt it would be much worse though. Very few people actually shave down to the skin like that anyways. My point is, the scars are completely different. If someone manages to notice the faint white dots... they'll have no idea what it is. One of the reasons the dots are inconspicuous, even if seen, is because they're spread out consistently on the back of the head. They look like some naturally occuring thing. Like freckles on skin.

 

The linear scar from FUT, however, looks anything but natural and is significantly easier to spot. Our eyes immediately pick up on straight lines.

 

Seriously? The picture I posted is dramatically obvious. It looks like they were sprayed in the back of the head with shotgun pellets. It does not take a trained eye to notice that degree of scarring. I appreciate that it is relatively less, but it is certainly painfully obvious.

 

In my opinion you think it's obvious because you're looking for it and know what it is. Now, the linear FUT scar in your pic does stand out because it is a massive line... the first time anyone looks at that guy's head, their eyes will quickly see it and identify it as a scar. They may not know why he has a massive line scar, but it will be obvious it's there and that it's some type of scar. The FUE dots are subtle because they're small and spread out over a large surface. Our eyes are not attracted to that type of pattern to begin with. It's inconspicuous. Even if someone discerns the dots, they won't know what they're looking at... are they some type of skin condition? sun spots? freckles? Who knows, who cares.

[Rootz]

We have already seen some not-so-good FUE scarring just as we have seen not-so-good strips. A doctor would be expected to advise the possibility that you won't be able to shave to a grade 0.

 

The fundamental difference is, if you go to a high end reputable FUE doc you will always have scarring as good or better as the example pic by bismarck. The same cannot be said for FUT. The wound that causes a FUT scar is entirely different. One is gauranteed if you do your homework, the other is far from it.

[KO]

Lorenzo posts in his videos what the patients scalp looks like after one FUE session prior to doing another, it doesn't look bad to me usually.

[1978matt]

The fundamental difference is, if you go to a high end reputable FUE doc you will always have scarring as good or better as the example pic by bismarck. The same cannot be said for FUT. The wound that causes a FUT scar is entirely different. One is gauranteed if you do your homework, the other is far from it.

 

We will have to take your word for it since virtually none of these patients shave to the bone post op. Maybe you can be the first and post the results.

 

I don't doubt the scarring can get pretty invisible for low thousands of grafts but when you get into the 5000+ territory it is a completely different ball game for some people.

[1978matt]

Lorenzo posts in his videos what the patients scalp looks like after one FUE session prior to doing another, it doesn't look bad to me usually.

 

His do look good but 99% of his results are on people with exceptional donor density.

 

Think of 50 x 50 square of beer cans placed on a floor. Randomly remove 100 of the 2500 cans and it won't be too noticeable.

 

Now take another 900 out. It doesn't look like a full palette anymore...

[chrisdav]

I don't doubt the scarring can get pretty invisible for low thousands of grafts but when you get into the 5000+ territory it is a completely different ball game for some people.

 

I agree with this. Scarring would definitely be noticeable shaving down to a zero bald scalp once you start taking large numbers like 5000-10000 grafts via FUE.

[Rootz]

We will have to take your word for it since virtually none of these patients shave to the bone post op. Maybe you can be the first and post the results.

 

I was commenting more on the variability in the outcome of the scars. How many bad FUE scars have come out of Bisanga, Feriduni, Lorenzo or any of the other high end FUE doc? I think the answer is exactly 0.

 

Think of 50 x 50 square of beer cans placed on a floor. Randomly remove 100 of the 2500 cans and it won't be too noticeable.

 

Now take another 900 out. It doesn't look like a full palette anymore...

 

Well keep in mind, in your example you removed 1000 cans out of 2500. That's 40%. Reputable docs will only harvest 15-20%, and 25-30% if you really want to push it. If you're concerned about your beer cans you can request a smaller percentage be harvested too.

 

And to be fair, the beer can anology isn't a great example because you can identify every beer can that is missing. But with hair, you can't even come close to identifying every hair that is removed. The granularity is much higher, the hairs overlap/cover each other, and the gaps (missing hairs) blend in partially with the surrounding hair.

[1978matt]

I was commenting more on the variability in the outcome of the scars. How many bad FUE scars have come out of Bisanga, Feriduni, Lorenzo or any of the other high end FUE doc? I think the answer is exactly 0.

 

 

Impossible to tell as not everyone posts and not everyone buzzes really short. It is impossible to claim a 100% success rate. Some people just keloid and there is nothing any doctor can do about that.

 

Apart from Lorenzo I don't really see 5000+ cases from Bisanga and Feriduni. I can only think of one guy who had about 6500 with Bisanga and posts on here.

 

You hardly see any stretched scars from the top FUT doctors either, including Bisanga, Feriduni, H&W. Both techniques performed properly have a low risk. It just bugs me that people seem to think everyone who gets a thin scar somehow managed to dodge a bullet, like it's a 50:50 chance. They conveniently forget about the outstanding yields, artistry and ability to move a lot of hair in one pass.

 

 

Well keep in mind, in your example you removed 1000 cans out of 2500. That's 40%. Reputable docs will only harvest 15-20%, and 25-30% if you really want to push it. If you're concerned about your beer cans you can request a smaller percentage be harvested too.

 

That's fine if you have average density and only need up to 4000 grafts (~30%). What happens if you need 7000?

 

And to be fair, the beer can anology isn't a great example because you can identify every beer can that is missing. But with hair, you can't even come close to identifying every hair that is removed. The granularity is much higher, the hairs overlap/cover each other, and the gaps (missing hairs) blend in partially with the surrounding hair.

 

I was using the analogy in the context of a shaved head. What you have just described requires long hair which defeats the object of FUE which is to be 'able to buzz it very short'. If you have to grow it out you may as well have a 2-3mm scar and dense hair in the donor.

 

The point I was trying to make is that you have a certain number of hairs/beer cans per cm, per inch, whatever, and if you keep taking more and more away there will come a point to which, from a distance, the gaps will be noticeable (at short length).

[1978matt]

This is a Bisanga patient, 2230 grafts, 12 months post op. Sure it looks fine now but how good after another 4000?

[hairweare]

Diffusely thinning the donor region by FUE harvesting is not necessarily a bad thing aesthetically. One aspect of a traditional FUT for a high NW class is the resultant contrast of density between the donor and recipient areas. With a large amount of FUE grafting the residual horseshoe can be far less noticeable and the overall look more natural appearing. This is evident in many of the Lorenzo videos where is difficult to delineate the difference between the donor and recipient zones.

[Rootz]

Impossible to tell as not everyone posts and not everyone buzzes really short. It is impossible to claim a 100% success rate. Some people just keloid and there is nothing any doctor can do about that.

 

 

There's a reason you never hear about bad FUE scarring from people going reputable FUE docs these days, because as long as an appropriate punch size is used it's a basically a sure thing. Bad FUE scarring is a thing of the past so long as you go to a reputable doctor and do your research. However, a lot of people keloid with their FUT scar no matter what. In fact you can argue everyone keloids to some degree, it's just a matter of how much.

 

You hardly see any stretched scars from the top FUT doctors either, including Bisanga, Feriduni, H&W.

 

All FUT scars stretch, it's just a question of how much. Most of the scars I see from recommended FUT docs here, including the top ones, look like the example bismarck posted... which with just a small section of hair pulled up might look OK, but shaved down shorter like the example pic then it's glaringly obvious.

 

In general FUT docs don't post very good shots of their patient's scar anyways... if they show a picture at all, it's usually a one small secton with some hair pulled up.

 

That's fine if you have average density and only need up to 4000 grafts (~30%). What happens if you need 7000?

 

30% is a bit extreme, I would suspect the average person could get more than 4000 grafts if their entire donor region was harvested at this rate. But I think we know what happens if you can't get all the grafts you need at 30%... either go above 30%, resort to FUT, or not get a HT at all.

 

 

What you have just described requires long hair which defeats the object of FUE which is to be 'able to buzz it very short'. If you have to grow it out you may as well have a 2-3mm scar and dense hair in the donor.

 

You consider 2-3mm "long hair"? That's pretty short IMO. I'm sure most FUT scars would be quite noticeable still. But with 2-3mm hair it would be almost impossible to determine if 0% or 20% (maybe more) had been harvested with FUE.

 

The point I was trying to make is that... if you keep taking more and more away there will come a point to which, from a distance, the gaps will be noticeable (at short length).

 

Agreed, but with that said keep in mind the more grafts you harvest with FUT the more notcieable the FUT scar will be as well. It will be wider and/or longer. I'll take up to 30% donor depletion over a big line scar any day.

[Rootz]

This is a Bisanga patient, 2230 grafts, 12 months post op. Sure it looks fine now but how good after another 4000?

 

Well to be fair, we only see an angle from one side of his head. How much of his donor area was actually harvested?

[KO]

Diffusely thinning the donor region by FUE harvesting is not necessarily a bad thing aesthetically. One aspect of a traditional FUT for a high NW class is the resultant contrast of density between the donor and recipient areas. With a large amount of FUE grafting the residual horseshoe can be far less noticeable and the overall look more natural appearing. This is evident in many of the Lorenzo videos where is difficult to delineate the difference between the donor and recipient zones.

 

This is also potentially true. In fact today, I was "examining" hehe the scalp of a guy at work, he was bald, but his sides were buzzed down, and they looked fairly thin and I believe I could see gaps, not saying he had an HT, but it didn't strike me as unnatural per se.

[BUSA]

ur not makn any sense. yea no chit u haven't seen it cause if someone was gonna shave their head down to the skin why wud they need a hair transplant?:rolleyes:

 

bottom line is with FUE u can shave down to a #1 so ur point is moot cause if anyone was gonna go lower there wud be not need for a HT.

 

The example you showed isn't shaved down to the skin. I mean, literally, shaved down to the skin with razor. I haven't seen that, because it's not possible.

 

[FUE2014]

I think some of this is being over-analysed.

 

Anecdotally, very few people, if any, come on here and complain about their FUE scarring. With FUT it is more of an issue, and much more obvious to the naked, untrained, eye. I frequently come across posts from guys who are seeking to have FUE to repair a scar from FUT, such as this guy:

 

http://www.hairrestorationnetwork.com/eve/176844-do-you-think-huge-scar-can-repaired.html

 

The scaring from FUE is much less obvious which is why people opt for it. It has a market because people are concerned about the linear scar from strip, why else otherwise would people elect to have FUE when the yield from FUT is supposedly better?

[BUSA]

that pretty much sums it up in a nutshell.

 

I think some of this is being over-analysed.

 

Anecdotally, very few people, if any, come on here and complain about their FUE scarring. With FUT it is more of an issue, and much more obvious to the naked, untrained, eye. I frequently come across posts from guys who are seeking to have FUE to repair a scar from FUT, such as this guy:

 

http://www.hairrestorationnetwork.com/eve/176844-do-you-think-huge-scar-can-repaired.html

 

The scaring from FUE is much less obvious which is why people opt for it. It has a market because people are concerned about the linear scar from strip, why else otherwise would people elect to have FUE when the yield from FUT is supposedly better?

[bismarck]

ur not makn any sense. yea no chit u haven't seen it cause if someone was gonna shave their head down to the skin why wud they need a hair transplant?:rolleyes:

 

I know you realize the obvious reply you're overlooking there. I mean later when their hair loss progresses (as most people's do) and the decision is made to shave the head.

 

At least part of the reason we haven't seen FUE scars needing revision yet is because the surgery is newer, so the progressive hair loss that results in people needing their FUT scars revised hasn't come up with FUE yet. But as someone suggested earlier in this thread, I suspect we will be seeing more cases of unfortunate FUE scars as the years go by, especially with more aggressive surgeons harvesting outside of the safe zone.

 

Again, this horse is beyond dead. The issue is simple -- the conventional argument for FUT has been accepting higher yield for higher scar.

 

The surgeons and patients that cement their opinion in favor of FUE will argue that the yield difference is minimal and increased transection with FUE only occurs with older FUE surgical techniques.

 

The surgeons and patients that cement their opinion in favor of FUT will argue that the terrible scars with FUT you see posted about in forums only occur with older FUT surgical techniques.

 

Likely both sides are partially right, but to what degree?

 

The real answer is: no one knows.

 

Every surgeon is different, every patient is different, and until we have randomized and double blinded clinical trials, which may not be for a long time, this overly opinionated and repetitive argument will continue being batted back and forth on the forums like some sort of Israel-Palestine debate that won't go away.

 

What is certain is this--anyone that comes down too emphatically on one side or the other is on some level blowing smoke. It is a major mistake to base broad sweeping conclusions on surgeon submitted cases on the forums, or, even worse, your own personal results.

 

The risks you're willing to take for the benefits you hope to gain are completely your own decision. The rest of the story, as they say, is not yours to write.

[Rootz]

At least part of the reason we haven't seen FUE scars needing revision yet is because the surgery is newer... But as someone suggested earlier in this thread, I suspect we will be seeing more cases of unfortunate FUE scars as the years go by, especially with more aggressive surgeons harvesting outside of the safe zone.

 

I think this is being a bit too dramatic. The FUE scars themselves will if anything just get smaller and even less noticeable as the field advances. I've never seen a case of "unfortunate FUE scars" from a top FUE doctor ever, and doubt I ever will. It's pretty hard to "accidentally" make a bigger hole than the punch size itself hundreds or thousands of times.

 

I doubt over harvesting will be something that trends upwards in any significant way, but who knows. In the event that it does, at least it could be avoided by just doing your research beforehand.

 

The surgeons and patients that cement their opinion in favor of FUE will argue that the yield difference is minimal and increased transection with FUE only occurs with older FUE surgical techniques.

 

Generally speaking I agree FUT will give a higher yield. But I believe the very best FUE docs have extremely similar if not the same yields as the best FUT docs. Lorenzo of course is the golden example. In fact I think a case could be made that Lorenzo has the best yield of anyone in the business, FUT or FUE.

[bismarck]

I think this is being a bit too dramatic. The FUE scars themselves will if anything just get smaller and even less noticeable as the field advances.

 

When I mentioned the passage of time, I meant as people who've had FUE have progressive hair loss into the harvested zones (ie their vertex continues to expand), then we'll see what the dots look like on "clean" skin.

[californian]

Hi folks, as the creator of this thread, I thank you all for your contributions and comments. I agree on some points, however, I strongly disagree with some of you guys on your opinions about the biased pictures provided here until now.

 

Here are more examples for biased pictures in the attachment.

 

The FUE example comes from the old ages of FUE, (or bad technique), 1.0 to 1.2 mm punches was used, so the dots were noticeable.

 

FUT scar is bad, because it is wide over back parts.

 

Both methods have some bad examples, you can compare those if you want. But don't compare a good example of a technique with the bad example of another technique. That's not fair and it doesn't make any sense.

[californian]

There are many different aspects of FUT and FUE that we can compare. Let's concentrate on one issue at a time.

 

Our starting point was stated by BISMARCK already: "Neither FUE nor FUT are perfect. Both have their drawbacks and benefits." (totally agree)

 

As a scenario, we will consider Dr.BestFUT and Dr.BestFUE are the most experienced, talented and perfectionist performers of their techniques with their teams. They obtain consistently good results, but due to the many variables and characteristics of the patients, they may sometimes have insufficient results, even may get so-called failures. But we do not consider this here.

 

The first topic is QUALITY of the SCAR, after one session of FUT or FUE.

 

We know that the range for graft numbers for one session of FUE and FUT is about 3000-5000 grafts, with average 4000 grafts. (FUT scar should extent from one temple to another for 4000 grafts as shown in many cases)

 

Here is very good examples of good FUE scar and FUT scar after about 4000 grafts. (FUT scar is a little low position than usual, but no need to consider this)

 

If anyone else could provide better examples of scars, I will replace it. (Maybe 1978Matt can provide us better FUT scar of himself)

 

Please look at the scars carefully, then decide.