How come an FUE/FUT combo can yield more lifetime grafts than FUE alone?

[olmert]

I don't understand why they can't pull as much hair out using FUE alone.

[KO]

FUT give you the most grafts compared to FUE, with FUT, you can extract ALL of the grafts in the really dense area in the occipital scalp, whereas FUE would only extract a portion from that space and spread its extraction pattern. After you are done exhausting your laxity, then FUE can be used to extract more grafts where FUT did not go, like the sides of your head etc, or if your occipital scalp still has adequate density.

 

To be clear, I'm not saying here that FUT is better than FUE, just that it yields more grafts.

[sl]

As KO said well, the techniques are different and do complement each other well in that one will take surface area (Strip) and the other (FUE) density and for more advanced loss can really work well to achieve a good result without over doing one technique as such and will get more than any one technique alone would.

[olmert]

My question is not that.

 

With FUT you are cutting out a strip of scalp, and then stretching the remaining scalp.

 

With FUE you are cherry picking grafts.

 

So I would think you could have five FUE surgeries, and cherry pick the entire donor area, and in the end get just as many grafts as if you had done a combination of FUE and FUT. But I understand you can get more grafts with the combination of FUE's and FUT's, rather than just getting a series of FUE's. Why can you get more grafts with a combination of FUE's and FUT's instead of getting only a bunch of FUE's?

[glocktop]

Olmert, the reason FUT yields more grafts is because you are extracting 100% of the grafts within the FUT strip. If you have a 7 inch by 1 inch strip, all those grafts are used. With FUE, you would never use 100% of the grafts within the same 7 inch by 1 inch area, because then you'd have a long bald strip spanning the back of your head.

When the FUT strip is removed, and closed, the skin below and above stretches somewhat and heals into the linear scar. The new density in the back of the head is actually lower now (less hair covering the same amount of surface area of your skull), but may not appear so at a glance. So if you removed 5k grafts, and ideally get a pencil thin scar, you've achieved a high yield without any visible loss of donor area density.

With FUE, you'd have to remove those same 5k grafts from all over the head, and if you extract too many from any one area, you'd get a patchy, or "moth eaten" look. In essence, visible density will be less to the human eye.

I guess to address the core of your question: if you get a big FUT that is well done, then that will allow a doc to subsequently cherry pick via FUE in later sessions throughout the remaining donor safe zone, and using his judgement and skills, extract the remaining viable grafts without visibly impacting the remaining donor area's density. So FUT + FUE = maximum extractions, with minimal subjective change to donor density. FUE alone just simply wouldn't get as many grafts, because again the FUT strip yielded 100% grafts in an area, where FUE will probably never want to take more than 50% in that same area to avoid changing the look of the area.

* Note, I just made up the 50% number for FUE... I'd be curious as to what a doc would say the magic number is for extracting follicles before affecting the apparent density of the area.

[KO]

^I believe SL said Bisanga takes 30% of density for FUE, you could ask Lorenzo what he targets.

[olmert]

Say the FUT cut out a half inch strip, giving 2000 grafts.

 

Say the skin one inch below and above the strip stretched out to cover the missing strip.

 

At the end of the day you have an area 2.5 inches wide with 2000 fewer grafts.

 

Why couldn't you have done FUE on this same 2.5 inch area and taken the same 2000 grafts? Glocktop says you cannot use FUE to take 2000 grafts out of a half inch area. But you can use FUE to take 2000 grafts out of the 2.5 inch area,

 

In sum, why can't a series of FUE's get the same number of grafts as an FUT/FUE combination?

[KO]

You could, but let me say that the "illusion of density" in the donor is better with FUT because the skin stretches to make the extraction look smoother, if that makes any sense. But I could be wrong, It's hard enough to see good patient posted results from top view, forget donor regions.

[hairweare]

Even If you achieve great density at the hairline and top which creates the illusion of fullness, that density will still be far less than the density of the donor region. This of course is an even greater contrast in higher Norwoods. If FUE is done skillfully the donor area will not appear any different that it did pre-op and the contrast between donor and recipient areas will be less which I believe to be desirable. If one if satisfied with a thinner than the original native but still visually aesthetic transplanted recipient area, why would a modest diffusely thinned donor area be of much concern?

 

I was a victim of 3 FUTs performed using a triple bladed scalpel. The many follicles which had to be transected in order to obtain those strips is a frightening thought. Even with today's more refined strip surgery, the blade has to transect follicles along the incision line especially those groupings that are in the telogen phase which the surgeon wouldn't be able to see and avoid even with loupes.

 

Before my recent FUE with Lorenzo, I went to see Dr. Rassman who thought my donor supply was pretty much exhausted and felt that at best only 500-700 grafts could be obtained. I eventually had 1500 by FUE and 8 months later I see no difference in my donor area other than the fact that the 6mm wide occipital scar is now pretty much covered up by the 300 beard grafts placed. Judging by the result of the other 1500 grafts in the frontal 1/2, if I can get anything close to the density result from another 1500/300 grafts to the back, I will be very happy that I didn't agree to another 500 graft FUT procedure.

[olmert]

Is KO saying that with FUT the skin is stretched uniformly, but with FUE the hair is plucked in a non-uniform way, so the FUT donor region looks more natural than an FUE donor region?

[Shampoo]

Olmert, the reason FUT yields more grafts is because you are extracting 100% of the grafts within the FUT strip. If you have a 7 inch by 1 inch strip, all those grafts are used. With FUE, you would never use 100% of the grafts within the same 7 inch by 1 inch area, because then you'd have a long bald strip spanning the back of your head.

 

That's interesting Glock...something I had never really thought about.

But could a patient choose a FUE using 100% of the grafts in 7x1 area,

if the patient was not worried about a "scar" or small blank spot that

would be easily covered by above hair just like with strip? In other

words if the goal of the patient was mainly a quicker healing time

and not having any stretch or tight scalp issues...and the patient

was not worried about a tiny FUE "scar" of blank line that is easily covered.

[Spanker]

That's interesting Glock...something I had never really thought about.

But could a patient choose a FUE using 100% of the grafts in 7x1 area,

if the patient was not worried about a "scar" or small blank spot that

would be easily covered by above hair just like with strip? In other

words if the goal of the patient was mainly a quicker healing time

and not having any stretch or tight scalp issues...and the patient

was not worried about a tiny FUE "scar" of blank line that is easily covered.

I don't think any doctor would do that and I don't think it should be possible without hacking up a lot of grafts. You would also have to consider that if you did that in phases there would be a lot of scar tissue hindering extractions and making it tougher to avoid transection.

 

What that would equal would be a really bad scar and less yield through transecting grafts. I can't think of any good reason to do that.