Should I get FUE before FUT, or FUT first.

[hairweare]

My sincere advice would be to become as skilled a FUE surgeon as a Lorenzo or Bisanga and elevate the practice in Turkey to the same level as it is in Europe. If indeed you price it at the same rate as the tech run clinics at home your reputation in no time should place you in great demand especially among Europeans who are looking for quality at a lower price point.

[Ali Emre Karadeniz]

My sincere advice would be to become as skilled a FUE surgeon as a Lorenzo or Bisanga and elevate the practice in Turkey to the same level as it is in Europe. If indeed you price it at the same rate as the tech run clinics at home your reputation in no time should place you in great demand especially among Europeans who are looking for quality at a lower price point.

 

 

How do you know I have not become as skilled as those names you mentioned?

I think the good Turkish surgeons are already at the level of the European surgeons and maybe even higher. However the average quality will remain much lower due to the large number of technician clinics that are allowed to operate in Turkey. I am blaming my country for letting these technician clinics operate, however I am aware that there is an incredible demand of them throughout the world. On the other hand I will never think about pricing as low as the tech run clinics, as I like to operate on just one patient a day and do all graft extractions and recipient site incisions. Doctors who plan for a hair surgery business have to choose between either running a technician clinic to do 10-20 patients a day for cheap, or just one patient a day done by the doctor for a higher price, although still much lower than their US and European counterparts. The first option is much easier than the second but is not suitable with my personality.

[hairweare]

I serious doubt that Dr. Lorenzo would agree with your claim that FUE is the more invasive of the two procedures and results in greater more significant scaring. He originally performed FUT and abandoned it years ago to perfect FUE. Again if you truly believe that it is inferior, in good conscience you should only do it for those rare cases where there is lack of scalp laxity. Also, by performing 90% of the procedure himself, he is limited to one case/day and expends far more man/hrs per case than if he were to hire technicians to do FUTS under his supervision.

 

It appears to me that many US physicians are offering robotic FUE in order to meet the rising demand for FUE while avoiding the learning curve required to perfect a newer technique or apportioning the greater degree of physician time FUE performed manually would require.

 

As you note the economics may be indeed different in Turkey, but your views on FUE do not serve to promote you well among prospective European and NA patients who do not want to undergo FUT.

[Ali Emre Karadeniz]

I serious doubt that Dr. Lorenzo would agree with your claim that FUE is the more invasive of the two procedures and results in greater more significant scaring. He originally performed FUT and abandoned it years ago to perfect FUE. Again if you truly believe that it is inferior, in good conscience you should only do it for those rare cases where there is lack of scalp laxity. Also, by performing 90% of the procedure himself, he is limited to one case/day and expends far more man/hrs per case than if he were to hire technicians to do FUTS under his supervision.

 

It appears to me that many US physicians are offering robotic FUE in order to meet the rising demand for FUE while avoiding the learning curve required to perfect a newer technique or apportioning the greater degree of physician time FUE performed manually would require.

 

As you note the economics may be indeed different in Turkey, but your views on FUE do not serve to promote you well among prospective European and NA patients who do not want to undergo FUT.

 

The discussions here are only our personal views. Nobody, including the names you mentioned are authorities who can decide on this topic. There will be many for and many against what I am saying. Why do you tend to compare other doctors approaches with mine? This is not a topic that should be squeezed between 2-3 names. Please also appreciate that I can not go beyond a certain limit in my comments about other names as I am identified and I should not be involved in discussions mentioning other names. Other doctors don't risk falling into these situations by not posting openly and use only representatives if they need to say something.

 

With your last words you are actually admitting that you understand I am not trying to promote myself. I am sharing opinions that may cause some people think I am afraid of doing FUE. On the contrary as a new surgeon in the market FUE was the first technique I learned and mastered. I have to emphasise that none of my opinions on this forum are aimed at promoting myself or a technique that I can do better than the other. The motivation behind them is only patient benefit, which I suppose is the main goal of this forum.

 

I intend not to prolong this discussion too long, as I don't wish to change your opinion. The community will have enough opportunities to hear what I think and see some of my examples which I will be posting in the coming days.

[hairweare]

We can agree to disagree of course but you did make some strong statements critical of FUE for all to consider on their own. The audience here is well informed and will make their minds up based on many factors and will use the information available in the forum as a valuable resource. It is appreciated that you are offering your profession opinions and experience and I look forward to seeing more of your results in the future.

[olmert]

1. I don't understand dr. karadeniz' excess skin argument. I don't see how it could be a way FUT could give grafts without decreasing donor density. If skin is bunched up - or in excess - I would thinking the bunching causes an appearance of greater hair density If you reduce the bunching — that is the skin excess — you will reduce hair density, I should think.

 

2. The neck stretching argument might be a way FUT gives grafts without decreasing donor density. Under this theory the hair line over your neck is raised up a bit. But how much is this hair line really raised? I thought almost all the skin stretching takes place within an inch of the scar. No?

 

3. I really wish I could get an answer to this: Why can’t you do FUE before FUT, and FUE harvest from areas no where near the FUT donor region?

[scar5]

1. I don't understand dr. karadeniz' excess skin argument. I don't see how it could be a way FUT could give grafts without decreasing donor density. If skin is bunched up - or in excess - I would thinking the bunching causes an appearance of greater hair density If you reduce the bunching — that is the skin excess — you will reduce hair density, I should think.

 

2. The neck stretching argument might be a way FUT gives grafts without decreasing donor density. Under this theory the hair line over your neck is raised up a bit. But how much is this hair line really raised? I thought almost all the skin stretching takes place within an inch of the scar. No?

 

3. I really wish I could get an answer to this: Why can’t you do FUE before FUT, and FUE harvest from areas no where near the FUT donor region?

 

All good points Ollie,

 

1) of course stretching decreases density, it is ridiculous to argue against otherwise, unless you argue that the diameter of the hair shaft itself 'stretches' too. Now that sounds unlikely.

 

2) The doc argues with you on this early in the thread (it's localized) , and then switches against you later. (it's global) So let's assume the neck accommodates 'some' stretch, the hair bearing zone 'some' stretch too. :confused:

 

3) It makes sense to do FUE first. You might get away with it (just FUE) for good. You might have a clean scalp (just look at the magnificent scalps we are now seeing regularly with heavy FUE harvesting) So why draw a dumb line across your head first?

 

The argument that fibrosis created in and around the FUE extraction sites makes strip sluicing or cutting tougher - who gives a #%&'! So do it hard! I don't care if the tech gets a sore hand, do you?

 

Multiple strip scars is butchery the doc says. Not so my doc, who was president of the ISHRS. One day, (and one day soon) they might say, strip is butchery, period.

Edited November 10, 2014 by scar5
Multiple strips > Multiple strip scars

[hadenough2014]

As a plastic surgeon and having performed both procedures many times and seeing results of others, I think that FUE is more invasive than FUT!

 

1. FUE takes much more skin out than the strip.

2. FUE leaves thousands of open wounds to heal with secondary intention. All of those small wounds are later filled with fibrosis which is scientifically the worst way of healing. The FUT wound is closed primarily which is the best way of wound healing. This is basic knowledge at medical school.

3. FUE wastes much more grafts than FUT while trying to extract.

4. FUE causes much more tissue damage, thus causing diffuse fibrosis all over the donor area. For this reason, it not only cancels out the chance to use the other technique in the future, but also significantly decreases the ability to get more grafts with the same technique for the future.

5. If I have a patient that has had a bad HT done before, I hope it is FUT. I know I have much more grafts left to improve his situation.

6. The chance of later using the hair shaven is not better with FUE than FUT. It may even be worse, as the FUT scar can be grafted while it is impossible to deal with thousands of white dots spread along the donor area.

 

One last comment that I probably need to add after being involved in FUT vs FUE discussions. I prefer to do FUE, because it is easy for me and I need less number of technicians which drops down the cost. I currently charge these techniques the same but I am recently considering to charge FUT even more than FUE. As a doctor I advice FUT, but as a clinic owner I hope the patient chooses FUE. I don't want anyone to think that I am a FUT surgeon trying the promote my technique. Turkish surgeons don't even know how to do FUT. The ones that know it have given up on it long ago, not because they think FUE is better, but because it is too difficult and costly to be able to provide FUT.

 

This is quite a thread! I was very torn between FUE and FUT. No single Dr. convinced me of what to do, but after extensive research I came to the conclusion that: 1) I will likely need a 2nd procedure down the road, as I was Norwood 5 for my first and would probably max out at Norwood 6 based on my family history, and 2) I do believe that doing FUT first is the best way to preserve as many grafts as possible to be available for a possible next procedure, which for me would probably be FUE as I do not wish to re-open what appears to be an excellent closure and scar healing at this point (day 24). I also expect a second procedure would be my last.

 

So, getting back to the original poster's question...I think he needs to look at his hair loss pattern likely the future. Is he likely advance from his current state to a Norwood 5 or 6 over the next 30 years? If so, I would say FUT first by an excellent Dr. who performs the most advanced closures. If his family pattern says he will max out at a Norwood 3 or 4, I would say he could do an FUE for his first procedure (then possibly using Propecia to prevent further loss). Either procedure should leave some donor grafts available for a second procedure, but fewer with FUE as the first procedure than FUT.

 

Lastly, he needs to be prepared that good doc will not tell him to maximize density at this point. He should target a very good, undetectable density, but he is too young to use so many of his donor grafts at his current Norwood stage. He needs to save some in case his hair loss accelerates in 5 years and he wants to do a second procedure, typically on the crown and top.

[ontop]

This is quite a thread! I was very torn between FUE and FUT. No single Dr. convinced me of what to do, but after extensive research I came to the conclusion that: 1) I will likely need a 2nd procedure down the road, as I was Norwood 5 for my first and would probably max out at Norwood 6 based on my family history, and 2) I do believe that doing FUT first is the best way to preserve as many grafts as possible to be available for a possible next procedure, which for me would probably be FUE as I do not wish to re-open what appears to be an excellent closure and scar healing at this point (day 24). I also expect a second procedure would be my last.

 

So, getting back to the original poster's question...I think he needs to look at his hair loss pattern likely the future. Is he likely advance from his current state to a Norwood 5 or 6 over the next 30 years? If so, I would say FUT first by an excellent Dr. who performs the most advanced closures. If his family pattern says he will max out at a Norwood 3 or 4, I would say he could do an FUE for his first procedure (then possibly using Propecia to prevent further loss). Either procedure should leave some donor grafts available for a second procedure, but fewer with FUE as the first procedure than FUT.

 

Lastly, he needs to be prepared that good doc will not tell him to maximize density at this point. He should target a very good, undetectable density, but he is too young to use so many of his donor grafts at his current Norwood stage. He needs to save some in case his hair loss accelerates in 5 years and he wants to do a second procedure, typically on

the crown and top.

 

Some great advice there dude....

Well done, great post.

[True]

Good evening, my name is "True."

Long time/first time.

On a virgin scalp, let's say I decide to undergo an FUE procedure which maxes out my donor FUE area.

Why can't I still do an FUT in the future with fewer grafts available in the "sweet spot"?

 

True, if I want to do an FUT in the future, my sweet spot will not be as robust as if I had done FUT first.

But, so what?

The reason for my depleted sweet spot would be because my sweet spot grafts would have already been put to good use in my original FUE procedure.

Basically, if I do FUE first, then my future FUT will not be as robust.

But if I do FUT first, then my future FUE will not be as robust.

So does it make a difference which procedure I do first?

I rather try an FUE before a possible FUT since FUT seems more invasive.

Edited July 8, 2018 by True
Add more

[hairlossPA]

10 hours ago, True said:

Good evening, my name is "True."

Long time/first time.

On a virgin scalp, let's say I decide to undergo an FUE procedure which maxes out my donor area.

Why can't I still do an FUT in the future with fewer grafts available in the "sweet spot"?

 

True, if I want to do an FUT in the future, my sweet spot will not be as robust as if I had done FUT first.

But, so what?

The reason for my depleted sweet spot is because my sweet spot grafts would have already been put to good use in my original FUE procedure.

Basically, if I do FUE first, then my future FUT will not be as robust.

But if I do FUT first, then my future FUE will not be as robust.

So does it make a difference which procedure I do first?

I rather try an FUE before a possible FUT since FUT seems more invasive.

I've thought the same.