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

[bismarck]

Just a small point -- in the long run, you get the maximum number of grafts from doing a combination of FUE + FUT, and you maximize your "sweet spot" DHT resistant follicle yield by doing FUT first. It seems wisest to pick and choose from either camp to maximize long term results.

 

The choice may be somewhat more relevant for people with milder hair loss, but if we're talking about maximizing total scalp yield, a combination seems to make most sense.

 

Important to keep in mind, however, that overdoing FUE or having a bad scar from FUT will make the combination more difficult.

[PupDaddy]

An absurd idea came to me--I wonder if part of the reason his success rates are so phenomenal, in addition to patient selection, is that he stays away from hairlines.

 

For example, does the relative lack of subcutaneous tissue at the temples and frontal scalp result in the 'skeletal grafts' of FUE having more difficulty successfully growing as compared to the bulbar 'chubby' grafts of FUT (and piloscopy). Many of the poor outcomes with FUE that I've come across from other surgeons appear to have been hairline issues. I have not really developed a sense of if this is more common with FUE than FUT.

 

I like how your brain works, bismark. What does that say about me?

 

I'm not sure about the validity of your theory. Dr. Diep comes to mind as an HRN-recommended FUE doc (who also does strip) who doesn't shy away from lowering hairlines and closing temples in FUE cases. He has lots of youtube videos showing really good FUE growth in such cases. I still think the very best outcomes in his video library are a couple of his strip cases but his FUE cases are impressive as well, and most involve lowered hairlines and temple work. And unlike Lorenzo, Diep makes it a point to show extreme closeup shots of his FUE hairline and temple work from various angles. So who knows?

[KO]

That wasn't the best FUE example , KO .The Lorenzo patient had plenty of hair before surgery and was cut short . The after photos show the hair grown out .

FUE is perfect for some guys but I personally would never do it . I can't shave my head due to work and social life . I never wear my hair super short so FUE makes no sense for me .

 

Err...I don't think it was cut very short, note I said diffuse thinner.

[PupDaddy]

An absurd idea came to me--I wonder if part of the reason his success rates are so phenomenal, in addition to patient selection, is that he stays away from hairlines.

 

For example, does the relative lack of subcutaneous tissue at the temples and frontal scalp result in the 'skeletal grafts' of FUE having more difficulty successfully growing as compared to the bulbar 'chubby' grafts of FUT (and piloscopy). Many of the poor outcomes with FUE that I've come across from other surgeons appear to have been hairline issues. I have not really developed a sense of if this is more common with FUE than FUT.

 

I like how your brain works, bismark. What does that say about me?

 

I'm not sure about the validity of your theory, though. Dr. Diep comes to mind as an HRN-recommended FUE doc (who also does strip) who doesn't shy away from lowering hairlines and closing temples in FUE cases. He has lots of youtube videos of such cases showing (apparently) really good growth. I still think the very best outcomes in his video library are a couple of his strip cases but his FUE cases are impressive as well, and most involve lowered hairlines and temple work. And unlike Lorenzo, Diep makes it a point to show extreme closeup shots of his FUE hairline and temple work from various angles. So who knows?

[KO]

Anecdotally, though, it is at least intriguing that photo and video comparison of the strip and FUE cases of doctors who offer both strip and FUE and are considered competent at both, often reveal better looking and more dense results with their strip cases.

 

I think this point is misleading. I think all of us agree that the best strip results show greater yield and better density than the best FUE cases. Even the most pro-FUE posters I believe will agree to that.

 

But the "best possible result" may not be what actually grows on your head, and in all likelihood the end result will be somewhere between the "best case" and "disaster", and that is the relevant set of results that should be determined.

[PupDaddy]

I think all of us agree that the best strip results show greater yield and better density than the best FUE cases. Even the most pro-FUE posters I believe will agree to that.

 

I bet not.

[Rootz]

I think all of us agree that the best strip results show greater yield and better density than the best FUE cases. Even the most pro-FUE posters I believe will agree to that.

 

Please refer to the Theorem of Lorenzo, page 7

 

An absurd idea came to me--I wonder if part of the reason his success rates are so phenomenal, in addition to patient selection, is that he stays away from hairlines.

 

I don't know about this, Lorenzo has done a lot of fairly aggressive hairline cases with the usual success.

[bismarck]

Great Wall of China seen from space.

Volcanoes here and there, whatever.

 

Not to be snarky, but this is actually a myth. The Great Wall cannot be seen from space.

 

 

Originally Posted by bismarck

An absurd idea came to me--I wonder if part of the reason his success rates are so phenomenal, in addition to patient selection, is that he stays away from hairlines.

 

For example, does the relative lack of subcutaneous tissue at the temples and frontal scalp result in the 'skeletal grafts' of FUE having more difficulty successfully growing as compared to the bulbar 'chubby' grafts of FUT (and piloscopy). Many of the poor outcomes with FUE that I've come across from other surgeons appear to have been hairline issues. I have not really developed a sense of if this is more common with FUE than FUT.

I like how your brain works, bismark. What does that say about me?

 

I'm not sure about the validity of your theory. Dr. Diep comes to mind as an HRN-recommended FUE doc (who also does strip) who doesn't shy away from lowering hairlines and closing temples in FUE cases.

 

Admittedly, there is a bit of hand having behind that theory. Regarding Dr. Diep, he is certainly a great surgeon, and more assertive than Lorenzo. However, when I look at some of the cases posted by his patients instead of by him (ie. 'asiandude' on this forum) I have noticed thinning at the temples.

 

This of course isn't necessarily just an issue with FUE, temple thinning seems to be common (I believe FollicallyChallenged had a tough FUT case awhile back, for example).

 

But really, there is not much my theory other than the musings of someone who probably has been spending too much time on the forums as of late. It just reminds me to keep a look out for similar cases in the future with docs that are more assertive with hairlines in their FUE work (ie. Mwamba, Erdogan, Rahal, Doganay etc.).

 

At the other side of the spectrum, I have also noticed Bisanga and Feriduni to be conservative with FUE at the temples as well. They really love their temple points. Some surgeons really prefer steep temples for kind of a Justin Theroux look:

 

 

I would be interested in seeing a paper on rates of graft survival for different regions of the scalp, especially comparing FUE to FUT (ie. vertex vs central hairline vs temples vs diffuse.

 

If anyone of you wise veterans are aware of data in this regard, that would be great. It leads us to directly ask a more specific question -- when comparing FUE and FUT, is one or the other better for hairline work vs vertex work?

 

This would help patients tailor their surgical choice to their specific hair loss situation.

[KO]

No, I disagree, I think the best FUT results I've seen usually exceed the best of Lorenzo's. Not to mention that Lorenzo's epic cases usually involve multiple surgeries unlike HW who have posted many single sessions greater thank 5k grafts, and even a 9k graft session.

[bismarck]

Please refer to the Theorem of Lorenzo, page 7

 

I don't know about this, Lorenzo has done a lot of fairly aggressive hairline cases with the usual success.

 

His yields are the best in FUE, but unfortunately I do not think they quite match up to the best of FUT (ie. Konior). Of course I realize this is a point that has been argued back and forth on the forums ad nauseum, so I'm only stating my own opinion. Until we have objective data, it is silly to take too firm a stance on this based on low resolution JPGs.

 

There may be some exceptions, but his hairlines tend to be conservative. This is a style choice, but perhaps there is a pragmatic component to it as well.

[KO]

Now again, to be clear I'm comparing Lorenzo's best to the best FUT, not FUT in general. A lot of the FUT cases I've seen on these forums are merely ok, which in my opinion lends some credence to the pro-FUE crowd.

[Rootz]

Lorenzo's hairlines are generally conservative, and he may not aim for the highest density, but his yields are the best I've seen. Typically in the hairline, with either FUT or FUE, there will be inconsistencies or little gaps here and there where grafts didn't come in. With Lorenzo's results it seems like every hair he plants grows. This is one of the reasons he's able to achieve large coverage with relatively small numbers of grafts.

 

And it's not like he's transplanting at low density either, it's just that he doesn't go "extreme." The density of his hairline results are really good actually.

[californian]

KO, my mate, here we talk about the quality of scar after FUE or FUT. The results are out of topic now. Please delete your last posts showing results, then we may continue.

 

 

For all others: I read and appreciate all your comments and contributions. But at this stage, any comparison criteria other than scar quality(i.e: survival rates) are out of topic, we can discuss on them later.

 

I assure you that the scars I brought here is one of the best examples of scars, approved by some physicians. Any better scar that you will provide will be replaced. Spanker or 1978Matt may be provide us much better scars for FUT. (But it must extend from one temple to another to compare with around 4000 grafts of FUE)

[PupDaddy]

KO, my mate, here we talk about the quality of scar after FUE or FUT. The results are out of topic now. Please delete your last posts showing results, then we may continue.

 

 

For all others: I read and appreciate all your comments and contributions. But at this stage, any comparison criteria other than scar quality(i.e: survival rates) are out of topic, we can discuss on them later.

 

I assure you that the scars I brought here is one of the best examples of scars, approved by some physicians. Any better scar that you will provide will be replaced. Spanker or 1978Matt may be provide us much better scars for FUT. (But it must extend from one temple to another to compare with around 4000 grafts of FUE)

 

 

Considering that the absence of a linear scar is the selling point for FUE, what exactly are you trying to prove with your question? The question is nonsensical if you are going to disallow context. It seems that what you really are seeking is a sound bite.

[bismarck]

Great Wall of China seen from space.

Volcanoes here and there, whatever.

 

Not to be snarky, but the Great Wall actually can't be seen from space.

 

I like how your brain works, bismark. What does that say about me?

 

 

It suggests that either we're on to something, or folie a deux.

 

I'm not sure about the validity of your theory. Dr. Diep comes to mind as an HRN-recommended FUE doc (who also does strip) who doesn't shy away from lowering hairlines and closing temples in FUE cases. He has lots of youtube videos showing really good FUE growth in such cases. I still think the very best outcomes in his video library are a couple of his strip cases but his FUE cases are impressive as well, and most involve lowered hairlines and temple work. And unlike Lorenzo, Diep makes it a point to show extreme closeup shots of his FUE hairline and temple work from various angles. So who knows?

It's true, Diep does go a bit more aggressive with hairlines. I have seen cases of his with asymmetric thinning at the hairline, however ('asiandude' for example). That being said, I have seen elites doing FUT surgery (ie. FollicallyChallenged) that have had tricky hairline results as well, so I wouldn't draw any conclusions.

 

Ultimately, this is somewhat of a hand waving explanation, and really more of a by product of spending too much time on the forums than objective data. However, it leads one to a logical, and more specific query--when comparing FUE to FUT, could one surgical technique better for a certain type of revision?

 

I would be interested in seeing data, if it exists, for rates of successful grafting for the two techniques at different regions of the scalp -- ie. vertex vs central hairline vs temple points.

 

Also would be interesting to stratify the likelihood of yield success with the different techniques by pre-existing Norwood, pre-existing finasteride/dutasteride/minoxidil, patient age, ethnicity, etc.

 

Of course such a study would probably have to incorporate Fox testing as a variable, which is something totally neglected in most of these discussions because we are only looking at pictures.

 

Ultimately, what I'm getting at is we need to start asking more specific questions: is FUE or FUT right for my specific scenario with my specific pattern of hair loss. This seems essential to consider alongside patient and surgeon preference, but again we are only in the infancy of our understanding of the two procedures.

 

Or, perhaps the study would be done and ultimately find no correlations whatsoever. This would be valuable knowledge as well.

 

By the way, Californian, I'm sorry but I really don't understand you. Are you using Google translator?

[BUSA]

most all of ur top FUE doctors these days have great yield. id say the top 15 FUE doctors have very similar yield success.

 

as far as FUT being able to utilize more grafts I think thats debatable these days.

[KO]

I don't think there are any really truly elite doctors in FUE outside of Lorenzo, and even in strip there are only a small number IMO - think HW, Konior etc. but it is a bigger group than the FUE surgeons.

 

bismarck - I think you citing the anecdote of FUE surgeons getting FUT themselves is pretty weak, I think you realize that each patient very different needs and goals. And if we are going to cite anecdotes, our favorite Spanish guy himself had 5000 FUE grafts done on a NW5. Could you tell by looking at him?

 

[bismarck]

most all of ur top FUE doctors these days have great yield. id say the top 15 FUE doctors have very similar yield success.

 

as far as FUT being able to utilize more grafts I think thats debatable these days.

 

Hard to say for sure, but certainly have noticed elite FUE docs themselves talking about having lower yields with FUE, although the percentages have varied pretty widely, and the only formalized clinical trials were posted earlier in this thread.

 

Strip is still the gold standard. Maybe when piloscopy becomes widespread, FUE will rival FUT, but I don't think its quite there yet.

 

Let's think about risk/benefit:

 

After reviewing and cataloguing 2100 cases, 600 patient submitted, from the 5 major forums from 'elite' surgeons (yes I literally have data files on my computer with 50-150 cases per surgeon, stratified by graft count and technique), I've realized the chance of getting a wide donor scar are a fraction of the chance of getting low yield from an FUE surgery. The chance of a moderate, as opposed to excellent yield, from FUE is significant. I have seen this significantly less often with FUT.

 

Granted, the scars were not observed long term, and I am judging yield by pictures only, so what are these observations really worth? Pictures lie, especially pictures of hair, so not much.

 

The surgeons themselves know somewhat better, although of course they are not blinded to their own results.

 

Also, there are a host of other variables that I have previously discussed in this thread that were not taken into account. Still, I think we should keep some idea of the numbers in mind.

 

So, which is a worse outcome to deal with? Bad yield or bad scar?

 

That depends on how bad the scar, and how bad the yield.

 

One thing is for sure: neither risk is zero, and both are lower than they used to be, at least from viewing cases over the last decade. Saying anything beyond that is meaningless without double blinded clinical trials.

 

Being too strict about picking a "corner" is really pointless, and speaks more about a poster's predetermined biases than the surgeries themselves.

 

Some tangential things I've come across are concerning, although not really well substantiated. More than once I've heard and read about FUE docs getting FUT surgery for themselves, or recommending it to their family.

 

Strange. Why wouldn't you have faith in your own surgery? I think a large part of it has to do with the vector of the extraction being essentially blind. High frequency ultrasound will certainly help with this (see attached image).

 

Incidentally, I wish SK told us who he was talking when he mentioned these FUE surgeons on BT, but of course that would have hurt their business.

 

The central fallacy behind the graph that started this thread is that the shift in interest and market share to FUE is primarily consumer driven. Does this mean the procedure is better?

 

No, it means it is more marketable.

 

I eagerly await piloscopy. But short of that, I'm not that impressed by claims of FUE yields being equal to those of FUT, *even* those of Lorenzo. Hopefully the clinical trials will be completed soon, and this debate will become antiquated.

[bismarck]

I don't think there are any really truly elite doctors in FUE outside of Lorenzo, and even in strip there are only a small number IMO - think HW, Konior etc. but it is a bigger group than the FUE surgeons.

 

bismarck - I think you citing the anecdote of FUE surgeons getting FUT themselves is pretty weak, I think you realize that each patient very different needs and goals. And if we are going to cite anecdotes, our favorite Spanish guy himself had 5000 FUE grafts done on a NW5. Could you tell by looking at him?

 

 

My understanding was that our favorite Spaniard had a strip procedure on himself, not FUE, although this is just hearsay.

 

By the way, I did a sub-comparison of the surgeons you mentioned, and the phenomenon still applied, although not as pronounced as with the larger group.

[californian]

BISMARCK, yeah I am using a Google Translator. Google Translator doesn’t show the words that start with a capital letter such as Lorenzo, Hassan, Wong, Konior, Ferudini, Rahal, Bisanga. That’s why I am not writing their names.

 

Ok, let’s start from the very beginning. It seems, the number of people who prefer FUE technique increase at an unprecedented rate. Is the "after FUT scar” the reason behind this trend? Do people think that FUE is “scar”less? What are advantages and disadvantages of these methods over each other. At the end of the day, are they equally successful or is one of them superior to the other?

 

My point was comparing both techniques from the beginning. I think we should do it in many aspects which are:

 

1. The quality of scar and people’s preferences accordingly (After one session)

2. The comfort of the patient during the procedure

3. The lifetime of grafts in both procedures

4. The appearance of the result in terms of naturalness

5. The appearance of the result in terms of coverage and density

6. The effects of the first session to the second session

7. Your suggestions that don’t occur to me right now

 

When we are making the comparison, we will assume the best results (theoretically).

 

First, I started with the quality of scars..

I put here the best 2 scars that I have found. If anyone of you can find a better one, i will change it and we can vote afterwards. I will count the people’s preferences and announce the results from here. And I will continue doing the same for the other factors.

 

It’s OK if we don’t reach to a conclusion. The point is discussing stuff with respect and fair play. I will declare my preference anyway. For my examples, I will go with FUT. I hope you can be this straight-forward. Can you?

 

For now, 2 people voted for FUT (me and promitiv). No one voted for FUE.

[1978matt]

Virtual non-scar:

 

http://www.hairrestorationnetwork.com/eve/167769-3950-fut-amazing-dr-konior-10.html

[KO]

My understanding was that our favorite Spaniard had a strip procedure on himself, not FUE, although this is just hearsay.

 

By the way, I did a sub-comparison of the surgeons you mentioned, and the phenomenon still applied, although not as pronounced as with the larger group.

 

According to Mickey85 who has communicated with him, he had 5,100 FUE done. On the Spanish forums they believe it was done by Dra Ximena Vila who is his business partner. Even Dr Reddy in London who is on this website had FUE done by his own team.

 

My Battle with hairloss | Dr Reddy Biograpy | Restore Hair Clinics

 

 

Can you name these FUE surgeons who had FUT done?

[KO]

I am curious, this pissing match about FUE vs FUT aside, do you have data on the "failure rate" where the patient was unsatisfied between "elite FUT", "total FUT", "elite FUE", and "total FUE"?

[FUE2014]

In terms of crown work, I have not seen any doctor, FUT or otherwise, come close to the coverage Lorenzo consistently achieves. The guy is obviously a freak of nature because whatever he is doing he is (in my eyes) surpassing the best of FUT with what we are led to believe is an inferior technique (FUE) ;-)

 

p.s. why do some doctors such as Lorenzo, Erdogan, Doganay, not do strip? Is it commercial reasons or are there other factors?

[bismarck]

I am curious, this pissing match about FUE vs FUT aside, do you have data on the "failure rate" where the patient was unsatisfied between "elite FUT", "total FUT", "elite FUE", and "total FUE"?

 

I didn't look at true "totals" for either because I didn't research everyone. The ratio of unhappy cases from FUE to FUT was about 3:1 of supposed elites. For the top guy in each field, I didn't find enough unhappy patients for the numbers to be that meaningful, but by gross visual estimate, I appreciated a difference in yield.

 

Again, I really wouldn't put a great deal of stock in these numbers because the total number of patient submitted cases is low, and not representative of the total population. And what is the clinical profile of the average patient that decides to post his case online?

 

Either procedure has its place, but in the right patient. If piloscopy holds up to its promise, both will be be antiquated.

 

Californian, I suspected as much! Google translator is a good program, but certainly has its limitations, which probably has led to the misunderstandings on the other threads between you and other users. I empathize because I've done the exact same thing on the foreign forums.

 

Regarding your questions, I will share my meager thoughts, but I would suggest doing your own research:

 

1. The quality of scar and people’s preferences accordingly (After one session)

100% of people would prefer the FUE scar to the FUT scar. There is really no debate here. Even with the best case scenario that you keep alluding to, you get a very recognizable line with a shaved head with strip, although shaving down to a 2 with FUT and a 1 with FUE is usually possible.

 

2. The comfort of the patient during the procedure

The FUE procedure is more comfortable than FUT, and healing time is less.

 

3. The lifetime of grafts in both procedures

The published data suggests that FUT grafts are more resilient with time. Users here will argue that these don't represent the true numbers of the "super elites" in either category, but this is really just opinion based on pictures and personal experiences. The only clinical trials suggest FUT grafts to be more durable.

 

4. The appearance of the result in terms of naturalness

Both look natural in the hands of a good surgeon.

 

5. The appearance of the result in terms of coverage and density

From images and clinical trials, FUT appears to be slightly better. Again, users here will argue that the best of FUE have minimized that difference (in particular Lorenzo), but I believe it is still there, even when comparing the best to the best.

 

6. The effects of the first session to the second session

Having repeat sessions is possible with either technique, but becomes more difficult and has slow growth rates, and probably lower success rates with each repeat. You eventually reach a "harvesting threshold" which would stop you from having repeat procedures with either technique, although it seems that maxing out on FUT and following up FUE would allow you a larger number of total grafts overall. Bad scarring from FUT would of course shortcut this process.

 

Alright, no more soup for me.