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

[BUSA]

if u look at the majority of results posted these days on this forum they are FUE not FUT. there are still millions of ppl that think Bosely is the best HT center in the world. ignorance is still alive and kicking in the HT world cause no FUE doctors are advertising.

 

strip is not the gold standard. in fact, as more and more time goes by strip will be for very unique cases only. less and less ppl are turning to strip.

 

a low yield from any of the top 10 FUE doctors these days just does not exist unless the patient has unknown medical issues being either the "X" factor or an undisclosed condition. but that wud be true for FUE or FUT.

 

the top 10 FUT doctors can and do still have patients that are left with a bad scar and it has nothing to do with surgeon skill.

 

so the risk of poor yield from top FUE doctors is essentially zero

 

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.

[Rootz]

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.

 

Which elite doctors specifically were you looking at? FUE is a newer technique and one that is more difficult to produce results with, so if you're looking at a large sample size I would expect a noteworthy difference in yield.

 

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.

 

Per the Theorem of Lorenzo you can consistently get exceptional yields from FUE. Convsersely, it is not possible for people in general to consistently get a narrow scar (also, for some people even a "narrow" scar is still too much to deal with).

 

... the chance of getting a wide donor scar...

 

I think regardless of if the scar is "thin" (i.e. 1-4mm) or "wide" (i.e. >4mm), if you shave down to a grade 1-2 the scar is probably going to be pretty noticeable either way. That's the problem with FUT scarring. You will likely never feel comfortable shaving down to a low grade. For some people that's acceptable... having a relatively huge scar that can be discovered by other people. And then of course, if you happen to produce mass amounts of collagen and/or have bad laxity there's the risk it could stretch considerably (>10mm) and turn into a nightmare.

[KO]

I would say the biggest strength of FUE lies in the fact that in many cases we are depending on medications to hold our native hair. If for some reason we are unable to take it in the future or perhaps the medications do not arrest hair loss, you can simply buzz your hair down to a low grade and move on with your life. With FUT you may not have that option.

 

In addition, I think people need to take opinions on this forum with a grain of salt, it is very typical for a patient who had a successful FUT procedure to diminish FUE results or at best damn with faint praise "oh...but he had great donor hair", or somebody who has had a good FUE result may blast FUT as "outdated" or other epithets. You can see it in this thread itself.

[bismarck]

Disagree with some of the above posts, but I'm not going to sour the thread any further as I have noted that it is entirely opinion at this point.

 

Good scars are consistently achieved by top FUT docs, but they are not entirely predictable. Same with FUE yield, despite insistence that it isn't so. Looking at cases, the former appears to be far more rare than the latter, but this is only my opinion. I don't want to post a list of individual cases or pictures that I thought were poor outcomes because it is insulting to both the patients and the surgeons. Also, I am not looking at the patients in person, or even on video most of the time, and certainly not looking at their grafts under high magnification.

 

The deeper point is that you should do your own research, and try to base your conclusions on patient submitted cases.

 

If you're comfortable with your research and/or happy with what you've had done, or are planning, that's where we'll leave it.

 

I would say the biggest strength of FUE lies in the fact that in many cases we are depending on medications to hold our native hair. If for some reason we are unable to take it in the future or perhaps the medications do not arrest hair loss, you can simply buzz your hair down to a low grade and move on with your life. With FUT you may not have that option.

 

 

This is an excellent point, and exactly my major concern at this point. My main hesitance with strip is that I plan to have children in the future, and expect some sort of loss when I discontinue the dut.

 

If the expected loss that occurs when I discontinue Avodart is irreversible, I would hate to be stuck on the beach, having burnt my boat when I came ashore, so to speak. If I already had children, or was able to predict no loss when I discontinued the dut, I would be less concerned.

 

I think people need to take opinions on this forum with a grain of salt, it is very typical for a patient who had a successful FUT procedure to diminish FUE results or at best damn with faint praise "oh...but he had great donor hair", or somebody who has had a good FUE result may blast FUT as "outdated" or other epithets. You can see it in this thread itself.

 

Another great point, thank you sir. Caveat emptor.

[californian]

Virtual non-scar:

 

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

 

Matt, sorry, but we can’t make any comparisons with this picture. Hair is longer (and no need to mention obscurity of the pic and the distance the picture was taken)

If, the examples I gave had their hair a couple of millimeters longer, their scars would be invisible like yours. We already know that.

 

I guess, we can’t get a better example from patient photos. But we can get it from doctors. However, FUT doctors somehow do not show FUT scar transparently and honestly. What about having your hair cut like the way it is in the picture I uploaded here, so that we can use it for comparison ? I hope your scar is not bad, better than the one i uploaded here. Let’s see.

[1978matt]

Matt, sorry, but we can’t make any comparisons with this picture. Hair is longer (and no need to mention obscurity of the pic and the distance the picture was taken)

If, the examples I gave had their hair a couple of millimeters longer, their scars would be invisible like yours. We already know that.

 

I guess, we can’t get a better example from patient photos. But we can get it from doctors. However, FUT doctors somehow do not show FUT scar transparently and honestly. What about having your hair cut like the way it is in the picture I uploaded here, so that we can use it for comparison ? I hope your scar is not bad, better than the one i uploaded here. Let’s see.

 

I'm not wasting my time with this thread anymore. There is a picture of my scar on my thread below (the link is at the bottom of my signature). Dr Konior told me it was basically 1mm wide when he inspected it.

 

Like others have said I don't really understand what you're hoping to get out of this thread. I'm guessing it is just another crude attempt to discredit strip.

 

There are lots of photos on here of people who shaved their scars visible which are better than the one you posted. You clearly aren't looking hard enough.

[gillenator]

I do agree that FUE has come a long way with more surgeons mastering manual FUE over the past five years or so.

 

IMHO, it really comes down to the patients' goals and surgeons skills.

 

I have seen plenty of outstanding FUHT and FUE work and also terrible FUHT and FUE, both in terms of yield and scarring.

 

And obviously only the best cases of either technique are presented in the forums by any clinic.

 

I also agree that pics presented by the patient are for the most part more accurate representations. But it's mostly the happy patients and not the ones who end up with substandard results who post them.

[californian]

http://www.hairrestorationnetwork.com/eve/176878-does-dr-lorenzo-post-most-honest-results-2.html

 

 

KO, look at the picture I attached. Although, no hair was transplanted to the area I marked, the density seems to have got better as much as the transplanted areas. No need to mention the difference in the hair color, hair length, and the lightness of pre and post pictures. I don’t want to create conspiracy theories but if doctors present their results with such intransparency, (just recently a doctor, who was insistent on posting pre pictures with wet hair, admitted his mistake) how are we gonna decide on which technique or result is better? or what is real or fake? What are we going to compare with what?

 

 

 

BISMARCK, thanks, your comments reveal that you have a very extensive knowledge on the topic, all of them are valid information. Can you say FUE or FUT is better, taking everything into consideration you have learned and experienced so far?

[KO]

It is not clear to me that the density got better (it might have due to finasteride), but it could also be due to the fact that there is a lot more hair around it and some of it is falling over that spot. The lighting is very similar and the background is identical, the angles are identical, and finally, regarding hair length, it is not possible to get hair length identical, however it is pretty close, it is not like it was shaved preop and grown out long post op.

[Rootz]

KO, look at the picture I attached. Although, no hair was transplanted to the area I marked, the density seems to have got better as much as the transplanted areas?

 

Yes, most clinics skew the result in their favor by using methods to emphasize hairloss in preop pics and then concealing hairloss in postop pics. It's pretty lame, and unfortunately almost every clinic does it to some degree. There was even a doctor earlier this year posting photos that had been clearly computer edited... I wonder how just how many clinics use computer editing that haven't been caught.

 

In your pic the guy's hair is longer post op and it's combed more favorably so that the hairs overlap more. Who knows what else was done, maybe the lighting is better... could even be wearing concealing for all we know.

[bismarck]

BISMARCK, thanks, your comments reveal that you have a very extensive knowledge on the topic, all of them are valid information. Can you say FUE or FUT is better, taking everything into consideration you have learned and experienced so far?

 

Well, that's the $64,000 dollar question (or multi-million dollar question).

 

It's kind of you to say I am knowledgeable, but I really don't know anything with certainty. I think anyone that is too sure about which procedure is better, with the limited information we have, is on some level not being truthful with themselves. Unfortunately, you are unlikely to hear an unbiased opinion about this, either on this forum or in real life.

 

There are at least a dozen threads on this board alone over the last 10 years addressing this same topic, and they all differ on whether the yield or the scar is worth it.

 

For example, to paraphrase a well known surgeon on here, "If you're planning on shaving your head in the future, hair transplants aren't for you." There is wisdom in noting that you cannot fully shave your head with either procedure. If my hair loss were to progress, I would want to completely go down to the skin. This makes me feel like the type of scar doesn't matter as much, but rather its presence or absence.

 

The problem with this statement is, who the hell knows if they're going to need to shave their head in the future? Sure, we have genetics, but no one really knows if we're going to run out of follicles, or if the medications will stop working, or if we're going to have chemotherapy one day and the hair doesn't come back afterwards.

 

I suspect, for me at least, I won't care after 50, but then again, I used to think I wouldn't care after 40.

 

There is also wisdom in noting that FUT has the most proven yields. Although FUE is improving, there is no way to accurately know by how much at this stage.

 

There is a general rule that more minor cases suggest FUE, while more extensive loss would require FUT. However, some would say a doctor like Lorenzo (FUE) could handle a large procedure. And some would say a doctor like Konior (FUT) would create a scar so minimal as to be irrelevant even in a small procedure. And either side would argue about to what degree the other was accurate.

 

So for some, FUE, others FUT, and for many, neither. I'm not trying to be cheeky -- this is the reality of the situation.

 

Ultimately, you have to make a choice, and stop letting life pass you by while you worry about your hair. If you're not careful, it will. About that, I am certain.

[FUE2014]

Bismarck makes some good points, but despite all of the above, you will note his preference is FUE to avoid the strip later down the road

 

Incidentally, for me I favor FUE, as I expect the dut, keto and minox to give out one day as my follicles become more sensitive to androgens, ultimately forcing me to shave my head. I'm not burning my ships.

 

FUE gives you options which you do not have with strip.

 

I have seen someone on this site make a good point before, that no one wants to have corrective cosmetic surgery to correct your corrective cosmetic surgery, which could happen if you end up with a scar that stretches, widens, becomes more noticeable in time. It's robbing Peter to pay Paul as it were.

[bismarck]

Bismarck makes some good points, but despite all of the above, you will note his preference is FUE to avoid the strip later down the road.

 

FUE2014, although I favored FUE when I wrote that, actually I have not been completely convinced in either direction. For better or worse, my opinion is still evolving.

[KO]

Yes, most clinics skew the result in their favor by using methods to emphasize hairloss in preop pics and then concealing hairloss in postop pics. It's pretty lame, and unfortunately almost every clinic does it to some degree. There was even a doctor earlier this year posting photos that had been clearly computer edited... I wonder how just how many clinics use computer editing that haven't been caught.

 

In your pic the guy's hair is longer post op and it's combed more favorably so that the hairs overlap more. Who knows what else was done, maybe the lighting is better... could even be wearing concealing for all we know.

 

I have no idea what Rootz is talking about. Hair length will never be identical, however it is close. The preop does not emphasize hair loss, neither does the post op hide it, it is simply a styled the way he presumably styles his hair.

 

This is perfectly reasonable documentation. I find it interesting that on one page you were going on about the Theorem of Lorenzo, and now you're suggesting that Lorenzo is using concealer in his result photos? Ohh.....I get it, you did not realize it was one of his results.

 

[KO]

The way I see it, if you are going to fight a war in self defense with the risk of death, you go all out. Think cancer. But if you're fighting a war of choice, shouldn't you have an exit strategy? What if the surgery doesn't work out and the grafts don't take?

[bismarck]

The way I see it, if you are going to fight a war in self defense with the risk of death, you go all out. Think cancer. But if you're fighting a war of choice, shouldn't you have an exit strategy? What if the surgery doesn't work out and the grafts don't take?

 

KO, this is a great point and I was thinking this as well until I realized you couldn't shave down to the skin.

 

A grade 0 may not be so much an exit as a peace treaty -- you still know how bald someone is.

[Rootz]

I have no idea what Rootz is talking about. Hair length will never be identical, however it is close.

 

I did not say it should be. A lot of clinics take their preop pics right after shaving down the hair for the procedure, and when the hair is longer it gives the appearance of "more hair." This is not always a coincidence.

 

The preop does not emphasize hair loss, neither does the post op hide it, it is simply a styled the way he presumably styles his hair.

 

Let's presume whatever fits our agenda. This is Lorenzo's case so there is likely a video showing everything anyways... meaning it probably doesn't matter that the hair was styled to layer up better post op in this one pic.

 

This is perfectly reasonable documentation... Ohh.....I get it, you did not realize it was one of his results.

 

You realize this one picture by itself is poor documentation, right? I don't know the full story either, including the situation with his Fin usage.

 

now you're suggesting that Lorenzo is using concealer in his result photos

 

The spin is real. Without seeing any other pictures/video, or knowing which doctor the pic was associated with, I wouldn't have ruled out the possibility.

[Rootz]

I was thinking this as well until I realized you couldn't shave down to the skin.

 

You can shave down to the skin with either FUT or FUE. It's just the FUT scar will be about 10x more obvious than the FUE dots. You can also medical tattoo the FUE scars a lot easier than the FUT scar. So while the exit strategy for FUE may not be perfect, it is certainly much better.

[KO]

KO, this is a great point and I was thinking this as well until I realized you couldn't shave down to the skin.

 

A grade 0 may not be so much an exit as a peace treaty -- you still know how bald someone is.

 

I think that these days, most men who shave their heads are assumed to be losing hair and is the acceptable way of dealing with hair loss, so you will never really hide that fact, and so I don't think you need to do a grade zero, I think for many people, even a grade 1 or 2 all over is probably the "happy place" where you still look like you shaved down, but it takes away the harshness of a shaved head IMO.

[scar5]

I think for many people, even a grade 1 or 2 all over is probably the "happy place" where you still look like you shaved down, but it takes away the harshness of a shaved head IMO.

 

Agree on many of your points however..

 

Guys that shave it all off usually tell me its their best, easiest and that women respond better to it than the buzz, particularly if there is an empty crown . I'm sure others with the buzz say otherwise. I think you would be more employable, more likely to get a lenient jury, rent an apartment, etc., with a little hair.

 

I have extensive strip and FUE scars and I actually look better completely shaved down except the strip scars show, thanks mainly now to the buckled skin at the seams of the strip scars highlights them. The bright wightish pink of the scars is somewhat SMP camouflaged. The overharvested FUE areas also look pretty mangy with one to two/three weeks growth on them.

 

I think Bismark's point about a super thin scar by Kornior (he actually happened to use Kornior) is somewhat misleading. There is no telling how thin a scar will be once the knife goes in, no matter who or how good the surgeon is. And my thinnest and widest scars came from the same surgeon.

 

And shaving is possible with FUE if you are lucky with skin tone.

 

 

I think the compete shave is more of a statement and the buzz at NW4,5 and 6 can actually make a guy look more ugly, particularly if he has a high color contrast.

Edited October 4, 2014 by scar5
left half a sentence

[KO]

Interesting, what do you think about a NW 4/5 guy getting FUE done over the front In an effort to create a buzzed look? I have always felt that a little bit of hair over the front creates a little more "balance" to your face, but just IMO.

 

Something like this:

 

http://www.abola.pt/img/fotos/rioave/2014/nunoespiritosanto10.jpg

 

I bet this guy could look better if he had conservative FUE done over the front.

 

http://platform-online.net/wp-content/uploads/2013/01/Pep-Guardiola4.jpg

[KO]

One problem I feel with FUE is the much greater opportunity for fraud. To me, FUE seems to be the sort of thing which is easy to learn, but very difficult to master, which explains why there are so many guys doing FUE, but very very few posting great results regularly.

 

FUT on the other hand requires you to have a strong surgical background, otherwise you would not be slicing open somebody's scalp, so in a sense, it is possible that the guys with a better background go into FUT.

 

I have even seen videos of patients who have done small scale FUE on themselves!. Furthermore, places like Maral Klinik (please avoid) the doctor merely supervises the surgery and nurses do the rest....would you want to go to a tech slicing open your scalp? Then again I have heard questionable rumors about Madhu's FUT clinic as well...

[bismarck]

Agree on many of your points however..

 

Guys that shave it all off usually tell me its their best, easiest and that women respond better to it than the buzz, particularly if there is an empty crown . I'm sure others with the buzz say otherwise. I think you would be more employable, more likely to get a lenient jury, rent an apartment, etc., with a little hair.

 

 

That's an interesting comment. Am I right to understand you're saying you feel that women respond better to the shaved head, but juries, landlords and employers respond better to a little hair? Is this from personal experience? :cool:

[Shadow of the EMpire State]

Having read this page and others for more than 10 years, I find it incredible that this topic is still a source of spirited debate.

 

Strip surgery is an outdated, invasive, and somewhat barbaric procedure that serves only those men with advanced hairloss. And frankly, most of those men aren't good candidates for hair transplantation anyway.

 

Keep this in mind: strip surgery is supposed to be a corrective procedure. Meanwhile, a significant portion of the people who undergo that procedure wind up needing a so-called scar revision to . . . correct their corrective procedure. By contrast, I think I've seen one such case with FUE----maybe. A corrective procedure should not require another corrective procedure. Also, there are other issues quite apart from visibility of the scar, such as nerve damage and persistent numbness.

 

Bottom line: everything I've seen, read, and learned about hair transplants since 2003 has led me to believe (a) that the failure rate of transplants is much higher than clinics lead the public to believe; (b) that the vast majority of men over NW4 will not realize a cosmetically acceptable result from a hair transplant; © that hair transplantation is best used on men over 30 who are NW 3 or less; and (d) that the only advisable procedure for those men is FUE.

[KO]

This is a great patient posted FUE result, with hairline shots.