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

[scar5]

The key point is that FUE and strip are no different. 5000 grafts will deplete the stock of hair in the donor region to the same degree regardless of whether it is strip or FUE. No difference. No convincing needed.

 

And one of those myths that gets peddled around by strip pundits.

 

But there are a number of reasons as to why the remaining hair might look better on a strip patient and as well as a few minor ones as to why it could be worse.

 

Strip looks better because

FUE extraction patterns are manmade and hence not perfect. Economics dictates it. They simply do not have the time/skill to do it manually without thinning out a few zones too much or too little. The robot may do it better.

 

The borders of the extraction zone for FUE can be abrupt and the change in tone apparent for the extracted zone vs the untouched areas

 

The natural fall of the hair, the way it sits /lies might be better, and certainly more even, when the neighboring hairs remain neighboring hairs even if they are further apart.

 

Pigmentation from the FUE scars could make the underlying skin tones pop out more making the hair look thinner.

 

Strip looks worse - apart from scar itself- because (and they are IMO minor problems)

Buckles, valleys in the skin change the way the hair sits

Changes in the plane of the skin viz-a-viz matching the angle of exit for hair above and below the line of excision may mean that the flow of the hair is changed

Trico closure causes some wierd misangled spikey hair.

 

In any case, a thinned out donor is a GOOD thing for a baldy. Less contrast to the weak areas

[Rootz]

If you tap out on FUE (for most people this is 4000-5000 grafts) a strip procedure becomes out of the question, i.e. too visible.

 

Interesting how it seems your stance is that FUT is a perfectly good and even advantageous option for many, but if 15-25% of the donor is harvested then FUT suddenly becomes out of the question. It's mainly the length of hair that conceals a strip scar, there's already plenty of density there to conceal the scalp. This is why it is typically impossible to tell FUE harvesting has occurred once the hair is grown out again. If the scar is visible after harvesting, pretty sure it would have been visible before as well.

[1978matt]

It happened in your case Bismark, it happened in Matt's case, my case, Jotronic's case - it happens in all cases. Visibly less dense, no idea, I don't care, but less dense, absolutely and you can calculate exactly how much if you do the maths

You simply now have less hair, but your skull is still the same size.

 

re calculation- a bit of approximation for lost telegon and excision line peripheral loss (but that is another story) would be needed if you really wanted to be technical.

 

I'm just making a point guys. It is so simple, what is wrong with you??

 

 

Here is a picture of my donor area before and after. Visibly less dense? I think not. However, I could show you some 4,500 FUE cases that look a lot thinner afterwards.

Edited October 8, 2014 by 1978matt

[1978matt]

The key point is that FUE and strip are no different. 5000 grafts will deplete the stock of hair in the donor region to the same degree regardless of whether it is strip or FUE. No difference. No convincing needed.

 

 

 

Not quite. Transected hairs (as much as 20%) would mean FUE caused more hair to be removed, i.e. more punches are made to compensate for damaged follicles during the extraction process. I'm talking in pure numbers of hairs taken.

 

Strip looks worse - apart from scar itself- because (and they are IMO minor problems)

Buckles, valleys in the skin change the way the hair sits

Changes in the plane of the skin viz-a-viz matching the angle of exit for hair above and below the line of excision may mean that the flow of the hair is changed

Trico closure causes some wierd misangled spikey hair.

 

In any case, a thinned out donor is a GOOD thing for a baldy. Less contrast to the weak areas

 

Strip looks worse with very short hair. We know that. Things like buckles and valleys are symptomatic of poor strip work. Changes of the flow of hair - accepted problem at short hair lengths.

 

A moot point regarding looking better with a thinned out donor. Some might consider that as looking like you are suffering a disease or something. Anyway, that's up to individual choice.

[1978matt]

Interesting how it seems your stance is that FUT is a perfectly good and even advantageous option for many, but if 15-25% of the donor is harvested then FUT suddenly becomes out of the question. It's mainly the length of hair that conceals a strip scar, there's already plenty of density there to conceal the scalp. This is why it is typically impossible to tell FUE harvesting has occurred once the hair is grown out again. If the scar is visible after harvesting, pretty sure it would have been visible before as well.

 

What I'm saying is it could happen. Take this chap for instance:

 

http://www.hairrestorationnetwork.com/eve/169436-dr-bisanga-bhr-clinic-2716-graft-hybrid-2056-fut-660-fue-0-10-months.html

 

Now I totally accept his initial work (not by Bisanga) was poor FUE work. But it shows a situation where it has become difficult to hide a scar after 4000FUE.

 

15-25% of donor might be 3000 for one person, or 8000 for another. What's concerning is the people with the former who head off to Turkey for 5000FUE without knowing that it could rule out strip in the future. If they get poor yield they are just totally stuffed with a thin donor and inability to have strip surgeries.

[KO]

Here they comb through his donor after 6k grafts, does it look thin?

 

 

 

Here is a donor site after 8000 grafts and a strip I think:

 

Edited October 8, 2014 by KO

[1978matt]

Here they comb through his donor after 6k grafts, does it look thin?

 

 

 

Here is a donor site after 8000 grafts and a strip I think:

 

 

Two guys with above average donor densities and deep wallets.

 

8,000 grafts = EUR34,000.

[FUE2014]

Another example of a FUE result from Lorenzo which yield wise is on a par with the best FUT, but without the long linear line at the back!

 

 

[1978matt]

Another example of a FUE result from Lorenzo which yield wise is on a par with the best FUT, but without the long linear line at the back!

 

 

 

 

That's great but....his donor density is unreal which makes this possible. Any examples out there with a normal donor area?

 

I did see a post on another forum by a respected rep (who I might add has had FUE himself) that <10% people have high density donors.

[KO]

Two guys with above average donor densities and deep wallets.

 

8,000 grafts = EUR34,000.

 

All good transplant results involve favorable characteristics, but only for FUE do we hear "oh he had a great donor." Btw, the 6000 graft case had average hair caliber, and how do you know the density of the 10k graft patient? Your prices are wrong, 8000 grafts would be = 6000 + 4000 + 2.5*6000= 25,000.

[1978matt]

All good transplant results involve favorable characteristics, but only for FUE do we hear "oh he had a great donor." Btw, the 6000 graft case had average hair caliber, and how do you know the density of the 10k graft patient? Your prices are wrong, 8000 grafts would be = 6000 + 4000 + 2.5*6000= 25,000.

 

Oh, I thought it was EUR6 for the first 1000 then EUR4 for all above.

 

You only have to look at the side of his head to see how dense it is. I anticipated a bit of a kick back on this one so here are several examples of average donor density and great FUT results:

 

http://www.hairrestorationnetwork.com/eve/136351-dr-hasson-5059-grafts-one-session-6-months.html

http://www.hairrestorationnetwork.com/eve/166466-dr-cam-simmons-%96-8787-grafts-3-sessions-norwood-6-7-patient.html

http://www.hairrestorationnetwork.com/eve/176942-dr-wong-4720-grafts-1-session-fut-13-months-post-op.html

http://www.hairrestorationnetwork.com/eve/165973-dr-ron-shapiro-6-months-1-year-3924-7606-a.html

http://www.hairrestorationnetwork.com/eve/164542-dr-cam-simmons-%96-4169-grafts-front-norwood-4-patient-fine-black-hair.html

http://www.hairrestorationnetwork.com/eve/141966-6-800-hairs-one-session.html

http://www.hairrestorationnetwork.com/eve/169390-dr-hasson-7061-grafts-2-sessions-17-months.html

http://www.hairrestorationnetwork.com/eve/167220-dr-cam-simmons-%96-3557-grafts-front-norwood-5-6-thinning-man.html

http://www.hairrestorationnetwork.com/eve/136157-dr-parsley-4-year-fu-5-000-futs.html

[gillenator]

None of us can deny the goals and even the profile of each patient. FUHT is not the choice of some individuals any more than FUE is. Not everyone is a candidate for FUHT and not everyone is a candidate for FUE.

 

Both techniques have their place...period.

[1978matt]

Compare the 3 Lorenzo patients to the Hasson one. Night and day in terms of donor density.

[scar5]

Meh..y'all just talking about impressions and subjective stuff.

 

Stick to the facts, and be logical.

 

4000 FUE grafts diminish your donor no more than 4000 strip - that we can say for sure, so no more of that nonsense about strip 'preserving' your donor.

 

i am absolutely sure FUE transection is larger than quoted - but I am also sure it is in the extracted follicles - much less so the peripheral stuff.

 

I mentioned the FACT that telegon hair is binned during strip, and that incision transection is also a factor - both of these losses come free with your strip transplant, but still you want to fudge the facts.

 

But even so, regardless of our banter, more and more people will choose FUE with every passing day and for good reason.

 

This thread had debunked another erroneous strip fable - that FUE depletes your donor more than strip.

 

Another one bites the dust.

[1978matt]

Meh..y'all just talking about impressions and subjective stuff.

 

Stick to the facts, and be logical.

 

4000 FUE grafts diminish your donor no more than 4000 strip - that we can say for sure, so no more of that nonsense about strip 'preserving' your donor.

 

i am absolutely sure FUE transection is larger than quoted - but I am also sure it is in the extracted follicles - much less so the peripheral stuff.

 

I mentioned the FACT that telegon hair is binned during strip, and that incision transection is also a factor - both of these losses come free with your strip transplant, but still you want to fudge the facts.

 

But even so, regardless of our banter, more and more people will choose FUE with every passing day and for good reason.

 

This thread had debunked another erroneous strip fable - that FUE depletes your donor more than strip.

 

Another one bites the dust.

 

You have not proved anything and pretty much every doctor would disagree.

 

Telegon makes no real difference between procedure. If you make a FUE punch over what you believe to be a '2 hair' follicle and the third hair is 'sleeping', this third hair may get killed or is binned - one or the other. You cant see the sleeping follicle in FUE or FUT. It makes no real difference. Someone making blind FUE punches has no better chance of knowing where a sleeping follicle is than they would via FUT.

 

As I said before, even Lorenzo at his best will kill 10% of hair follicles so for every 5000 hairs (approx. 2500 grafts), 500 get binned. A comparible proportion will also get binned during the strip scar excision, depending on the care taken. I have heard that the strip number can be quite low if a surgeon takes time to excise the strip.

 

If you start with FUE the doctor punches FUE in the area that would otherwise have been taken by a strip. 10%+ will get killed during the extraction process, therefore if you come back later and take the strip area it will be depleted by the number that were killed off during previous FUE surgeries. Surely you can understand that. I'm not fudging any facts and it makes perfect logical sense: if you FUE the strip area a certain number of follicles get wasted that would otherwise be taken had the strip been removed initially before any FUE took place. These binned follicles also happen to be some your most stable and DHT resistant hairs.

Edited October 9, 2014 by 1978matt

[Loags79]

Bad FUT scars don't happen as much now days compared to the past, esp from top surgeons. Just like yield for fue is better now than it was in the past.

 

I like the idea of FUE scar being aesthetically superior but what concerned me is that the extraction process is blind process. The other thing about fue is the thinning in the donor area once 3000-4000 grafts are removed.

[Rootz]

Bad FUT scars don't happen as much now days compared to the past, esp from top surgeons. Just like yield for fue is better now than it was in the past.

 

The thing is, a good FUT scar it still orders of magnitude more obvious than FUE scars. As for the yield, Theorem of Lorenzo. QED.

[1978matt]

This is all rather boring for readers and detracting from the main issue which is the result on the top of your head.

 

If someone can find a person with average donor hair density (like 90% of the population) who had 5000 FUE and then followed up with an FUT procedure then give me nudge. I'd like to see if they still maintained a normal looking appearance and got enough hair on the top of their head.

 

I'll sign off with a few comments from the good Doctors of this network...

[1978matt]

Dr Bernstein:

“…there is considerably less total donor hair available with FUE, perhaps half as much as with FUT. This represents a significant disadvantage since a limited donor supply is the main factor that prevents a complete hair restoration in many patients.”

“FUT (via strip) will give the best cosmetic results (more volume) since the grafts are of better quality (when using microscopic dissection, there is less transection and more surrounding tissue to protect the grafts) and better graft selection (the grafts can all be harvested from the mid-portion of the permanent zone).

In contrast, in FUE you need approximately 5 times the area. Because of this large donor area requirement, some of the hair must be harvested from fringe areas and thus the hair will be less stable genetically.”

 

“In general, FUT will give you more hair since, in FUT, the best hair from the mid-portion of the permanent zone of the scalp (also called the “sweet spot”) can be utilized in the hair transplant.

With FUE, since only the hair follicles are extracted and not the surrounding bald skin, if too much hair is removed, the donor area will begin to look thin as hair is removed. This will limit the amount of hair that can be harvested.

Although in FUE additional areas of the scalp can be utilized to some degree, this will generally not compensate for the inability to access all of the hair in the mid-permanent zone and the total amount available for the hair restoration will be less.”

 

Dr Bisanga:

“Hair characteristics and FU constitution can play a large part in how suitable FUE can be; it is misunderstood that FUE is suitable for all hair loss stages and hair types and some may not have the right attributes to ensure a solid result”

Dr Carman:

“It should be pointed out that this method has it's own limitations and complications, as follows. Because of the need to intersperse the excisions evenly within the areas of hair that are not harvested (for cosmetic reasons), there is a limitation in the amount of hair that can be harvested at any one time utilizing this technique, and it typically yields one-half the amount one would obtain otherwise”

Dr Charles:

“As a final consideration, you should be aware that not all patients are candidates for FUE. It can be very difficult to remove intact follicular units from certain patient’s scalps and as a results, a greater portion of these grafts may be damaged than if they’d been removed using FUG. At the beginning of each FUE procedure a small sample of extractions is attempted to determine if the patient is a good candidate for this type of procedure.”

[1978matt]

Dr Feriduni:

“An FUE is best for patients wanting to avoid a linear scar at all costs, and for younger patients only requiring minor treatment”

“Patients with a Norwood V or VI diagnosis should choose a combination of FUE and FUT to attain the highest possible number of donor hairs.”

Dr Kabaker:

“Most young men having hair transplantation end up having 3000 to 8000 grafts done in their lifetime. If this is harvested by the FUE method, I can almost guarantee you would not be able to shave your head and not look remarkable with a bunch of white dot scars”

Dr Konior:

“Poor Candidates: 1) Those who extract poorly

2) Those who will need multiple thousands of grafts..”

Dr Mohebi:

“Not every patient is a good candidate for FUE procedure. We strongly advise testing every patient before planning to do an FUE procedure. This is done by using a FOX test ..”

Dr Ron Shapiro:

“Although new techniques and instrumentation have significantly decreased the amount of transection and damage during the extraction, the inability to fully access the mid-portion of the permanent zone in a hair transplant procedure significantly limits the total amount of hair that can be accessed through FUE, rendering it a far less robust procedure than FUT for moderate to advanced balding.”

[1978matt]

Dr Wesley:

“One of the major potential drawbacks of FUE is the possible extraction of grafts that contain hair that is more likely to be lost over time. This potential problem stems from the mutual desire of both the physician and the patient to maximize the yield of transplanted FU in a single session. In general, the greater the number of FU transplanted using FUE, the more likely the session may include fewer permanent hairs and more temporary hairs that are destined to thin and ultimately disappear..”

 

Dr Karadeniz:

 

“…FUT preserves untouched donor for FUE but FUE destroys the FUT area which could give the best grafts of the donor area.

The other reason is related to mechanics. The physical principles that each depend on are different. FUT takes advantage of skin laxity and then elasticity. FUE just reduces density. The techniques are actually not alternatives - which is the reason why I don't like FUT vs. FUE type of discussions very much - but complementary in getting the most out of the donor area. If we don't start with FUT, we loose the chance of taking some of the grafts via skin laxity, because we take lets say 30-50 % of the grafts from the skin excess instead of taking 100%.”

 

Dr Wong:

 

[Rootz]

None of those quotes are from world class FUE docs except Feriduni and Bisanga IMO, and their quotes aren't really conclusive of much. Konior specializes in FUT so I'm not surprised he has reservations about it.

 

Also... Theorem of Lorenzo

[FUE2014]

 

Also... Theorem of Lorenzo

 

Wonder how long those three words are going to take to become a permanent fixture across the hair restoration community in FUE vs FUT debates

[gillenator]

Every one of the surgeons' comments have valid and legitimate points and can only be realized from them actually performing both techniques.

[sumitbharghav]

I was doing kind of a research on Google. I found this graph

 

FUE vs. FUT comparison by years - Google

 

 

just because of its better result.