Are some people choosing FUT for lack of intelligence?

[delancey]

Hey Matt, did you experience other side effects besides sluggishness?

[1978matt]

Hey Matt, did you experience other side effects besides sluggishness?

 

Just trouble concentrating (minor brain fog) and tiredness. Nothing else.

[delancey]

Cool! Doesn't sound too bad.

[olmert]

Man, I myself did not feel any sluggishness, just a complete loss of libido. I mean complete. I could not believe it. So I stopped taking it entirely. I wish I knew some way around the libido loss, so I could keep taking it.

[scar5]

Let me.....try not to generalise;

 

I have never had a previous FUT patient who had run out of donor hair ....

 

..FUE, especially when done by technicians, had depleted the donor area about 6000-7000 grafts while only giving a yield of 2000-3000 grafts.

 

There you have it folks.

Straight from the horse's mouth. **

 

**A recommended Hair Transplant Network Doctor no less.

 

Never had a strip patient run out of luck...(but that's just his experience)....on the other hand...

 

"FUE done.." (= not one case) "especially by technicians" (= not so always, but it tends to be so!)

 

"had depleted" (= ??? uh? One case? We are now talking of one case?)

 

.. Or are we using a sleight of tongue to conflate the effect...so that some of us walk away reading it as ...FUE = 35% (disclaimer #1 -tends to be more with technicians) (disclaimer #2 - I could be referring to just one case, but you don't know, so let's just assume it is all bad, where there is smoke there is fire)

 

Shocking post.

 

But I agree that yield is probably much lower than quoted, and yes, especially with technicians and drills.

Edited December 28, 2014 by scar5
Clearer

[1966kph]

Scar5 both Lorenzo and Erdogan IMO 2 of the very best when it comes to fue have techs doing extractions and there are many more to and they've been doing it for years with outstanding results.

Dr karadeniz uses motorised fue as do many others.

Anyone who thinks that a fut op or two then going fue is gonna give less fu's than fue alone wants their head read and I thought this logic had been unstood many years ago and is not a revelation dr Karadeniz has just brought to light.

Have a good day all

[Matt27]

There you have it folks.

Straight from the horse's mouth. **

 

**A recommended Hair Transplant Network Doctor no less.

 

Never had a strip patient run out of luck...(but that's just his experience)....on the other hand...

 

"FUE done.." (= not one case) "especially by technicians" (= not so always, but it tends to be so!)

 

"had depleted" (= ??? uh? One case? We are now talking of one case?)

 

.. Or are we using a sleight of tongue to conflate the effect...so that some of us walk away reading it as ...FUE = 35% (disclaimer #1 -tends to be more with technicians) (disclaimer #2 - I could be referring to just one case, but you don't know, so let's just assume it is all bad, where there is smoke there is fire)

 

Shocking post.

 

But I agree that yield is probably much lower than quoted, and yes, especially with technicians and drills.

 

First, he states that the problem is especially apparent when FUE is performed by technicians. Later, he claims that the problem lies not with skill level, but is inherent to the technique itself. Shocking posts indeed.

 

most of my patients who had a previous FUE procedure were either non-operable or had little chance of improvement. The main difference I see is not that the first procedure had used up most of the donor hair, but FUE, especially when done by technicians, had depleted the donor area about 6000-7000 grafts while only giving a yield of 2000-3000 grafts.

 

I believe the problem I mentioned is inherent in the techniques and is beyond the importance of whether the grafts were extracted by techs or docs. The problem is still there even if it is done by docs. I have felt in many occasions after doing an FUE (despite offering the patient FUT first) that just by choosing to start with FUE, the patient has sacrificed a much more effective hair restoration for the long run.

 

A 35% yield pretty much never happens. He was exaggerating to make his point clear. I myself think he should re-post with realistic numbers.

 

I do not think that the exaggeration was added to strengthen any point. We're all adults and benefit most from accurate information. It seems like he is doing whatever he can to discredit FUE.

 

Having said that, he is a HT surgeon and I am not. And maybe he is privy to information that we aren't. Maybe what he said is common even with top surgeons. I would like him to clarify this as well.

Edited December 28, 2014 by Matt27

[Matt27]

I'm sure the doctor will clarify but he's not talking about growth yield. What he's saying is that the technicians take the equivalent of 6-7k grafts just to get 2-3k suitable for implantation in the donor area.

 

I.e. The patient goes in for a 3000 graft session but the technicians just drill away until they get the required amount of hair follicles that are not damaged. In the process of doing so they damage 3-4k follicles which get thrown away.

 

Wouldn't 6k completely deplete someone's FUE donor?

 

There are countless 3k FUE cases posted on this website. Can you point me to an example where it looks like 6-7k grafts were extracted to get 3k grafts suitable for implantation?

[olmert]

There you have it folks.

Straight from the horse's mouth. **

 

 

Never had a strip patient run out of luck...(but that's just his experience).

 

 

 

Now, wait a minute, I do agree that the doctor should clarify.

 

I had a doctor tell me during a consult "you can always use more hair." He meant that no one getting a hair transplant can improve so much that he gets back to a stage before he started to bald. He meant no one has that many donor grafts. And I know many patients who have been told by doctors that they cannot get any more FUT's because they ran out of scalp laxity.

 

And so there is no such thing as not running out of donor hair.

 

 

And Matt27, Dr. K is saying that FUE is inherently inferior to FUT, but is even worse when performed by bad tech's. There is no contradiction in Dr. K saying all FUE is bad and FUE by bad tech's is even worse.

[Matt27]

And Matt27, Dr. K is saying that FUE is inherently inferior to FUT, but is even worse when performed by bad tech's. There is no contradiction in Dr. K saying all FUE is bad and FUE by bad tech's is even worse.

 

I can understand that but saying it is "beyond the importance of whether the grafts were extracted by techs or docs" makes it sound like skill level doesn't matter. Especially considering the context of the post he was replying to in which the user was asking whether we should avoid FUE clinic who use techs for extractons.

Edited December 28, 2014 by Matt27

[1966kph]

I have found many contradictions in what dr karadeniz says in his posts in several threads whether this is down to a language barrier I don't know but I doubt it is.

I think and maybe the doc can correct me here what he is saying is that without maximising yield by going with fut first you are loosing precious donor grafts whether they are extracted by a doc or a tech is somewhat coincidental fue depletes the donor region without being able to collect anything like the number of viable grafts that fut would produce.

This is nothing new and has been discussed exhaustively here many times.

Hasson and Wong did one fut and got over 10.000 grafts most if not all ht candidates do not have a donor region capable of producing that many grafts via fue. That patient could possibly go for another fut then go for fue and could possibly end up with a graft count over 20.000. Without hair multiplication fue is never going to get anywhere near half that figure.

There's no shock in these posts apart from that I thought this was common knowledge.

Have a good day all

[fisher4man]

I can understand that but saying it is "beyond the importance of whether the grafts were extracted by techs or docs" makes it sound like skill level doesn't matter.

 

And experience. It sounds like beginner FUE doctor can extract better than skilled technician with many years of experience.

 

When talent and experience of a doc. or tech. is equal, transection of grafts during FUE graft removal mostly depends on the curliness of the hairs,

 

Anyway, I do not think Dr. K. is saying FUE is bad, because he has posted 5-6 FUE cases to become a recommended doc. here, not FUT.

 

:)I have an imagination that women can perform better FUE graft extraction than men, regardless they are doctors or technicians or nurses, very personal opinion but:)

[Ali Emre Karadeniz]

I would like to know how common 35% yield (2-3k of 6-7k) is with FUE. That definitely doesn't sound like something common with top physicians, especially those who perform exclusively FUE.

 

Please note that in the mentioned example, the yield is not 35%. In fact the yield may be 100% after those 2-3k is transplanted. However in order to get 2-3k, another 3-4k have been wasted from the donor area, which will be totally unknown to the patient until he goes for another session.

[Ali Emre Karadeniz]

I don't understand why you can't do the FUE first and extract from areas away from the the FUT donor zone. Then later on do FUT.

 

Ofcourse we can do this, however it practically never happens, as if the patient does understand the value of FUT, there is no reason why he will not start with it. If he doesn't understand it then he doesn't accept to get 30-40% less grafts just to protect the strip area for the future.

[1978matt]

Wouldn't 6k completely deplete someone's FUE donor?

 

There are countless 3k FUE cases posted on this website. Can you point me to an example where it looks like 6-7k grafts were extracted to get 3k grafts suitable for implantation?

 

Most cases on here are by reputable surgeons. However, one case did spring to mind. I tried to find the posting but I can't remember the surgeons name. I remember he was asking 'How many grafts did I get?' and his donor had an unbelievable number of holes.

 

I think it was this guy:

http://www.regrowhair.com/wp-content/uploads/2014/11/Poor-Technique-1.jpg

See also:

Highlights from the 2014 ISHRS (International Society of Hair Restoration Surgery) Scientific Meeting in Kuala Lumpur, Malaysia | Hair Loss Q & A

 

There's similar information to what Dr Karadeniz is saying at the bottom of this blog on the HDC website:

 

Large FUE sessions

 

I quote from the bottom of the above page:

 

"The danger of a rushed extraction of a large number of grafts that is planned in a short period of time is that the area will be overharvested and disabled for future procedures. Especially in the case, and we see so many these days, that a not so skilled surgeon attempts to extract 4000 grafts or more, usually assisted by mechanized FUE extraction devises, the surgeon needs to punch up 7000 grafts to end up with 4000 non transected which will result in huge wastage of the donor and high depletion."

[Matt27]

Thanks for that. That seems highly unethical :eek:

[newbie33]

Jesus Christ!

[hadenough2014]

I do not think that the exaggeration was added to strengthen any point. We're all adults and benefit most from accurate information. It seems like he is doing whatever he can to discredit FUE.

 

He is an FUE doctor. Read his prior posts and patient cases posted on this site. Why would he say something in an attempt to discredit his golden goose in Turkey? He is just being honest and saying what most any ethical doctor will tell a prospective patient about taking care to preserve donor follicles properly. I find his posts on this topic to be entirely consistent with the advice of many doctors with whom I consulted in the USA, who also do both FUT and FUE. By the way, many of them are now doing more and more FUE in the USA due to patient demand, but it remains a laborious task for doctors (and expensive for patients) as technicians are NOT allowed to do extractions under the medical laws in many US states.

 

IMHO - If preserving large donor area for the future is a priority for a patient, FUT first is the way to go without question. If a patient wants to take a chance that a single FUE session will cure his baldness for all time, then go for the FUE and be able to wear short hair. FUE is also good for touch-up and small sessions where the patient likely will not have much future hair loss by way of genetics.

[KO]

Er, can we see some data to back up these numbers rather than relying on, "argument by reputation"?

[Matt27]

He is an FUE doctor. Read his prior posts and patient cases posted on this site. Why would he say something in an attempt to discredit his golden goose in Turkey? He is just being honest and saying what most any ethical doctor will tell a prospective patient about taking care to preserve donor follicles properly. I find his posts on this topic to be entirely consistent with the advice of many doctors with whom I consulted in the USA, who also do both FUT and FUE. By the way, many of them are now doing more and more FUE in the USA due to patient demand, but it remains a laborious task for doctors (and expensive for patients) as technicians are NOT allowed to do extractions under the medical laws in many US states.

 

IMHO - If preserving large donor area for the future is a priority for a patient, FUT first is the way to go without question. If a patient wants to take a chance that a single FUE session will cure his baldness for all time, then go for the FUE and be able to wear short hair. FUE is also good for touch-up and small sessions where the patient likely will not have much future hair loss by way of genetics.

 

You gave another reason why American physicians may not be so enthusiastic about FUE. It is laborious and maybe not overly profitable for them. And they can't increase their rates beyond what they are to make up the difference because they would become completely uncompetitive with FUE docs in Europe.

 

I doubt someone as conservative and forthright as Bisanga would consider FUE a viable practice if he ever lost so many donor grafts.

[olmert]

There is one issue that Dr. K has not explained much or any.

 

First lets take all the bad doctors out of the equation and bad techs who waste grafts so they can work fast. Let's assume you go to a good FUE doc.

 

Now, second you have the FUE loss issue that a second FUE wastes more grafts than the first FUE. This is because the first FUE causes scarring, which complicates the second FUE.

 

Let us take factor two out of the equation by considering someone doing a first mega session FUE like 6,000 grafts, or alternatively doing less, but totally depleting one donor area of harvest-able grafts, such that it retains only the coverage it needs to keep from looking sparse, and will never be touched again, with later FUE's being done on different donor areas. Now there is no scarring second FUE issue.

 

So with these factors out, why is Dr. K still saying that you can get more grafts by FUT instead of FUE.

 

Now, Jojotronic said there is a reason that is hard to understand. He said it was "qualitative" and not "quantitative." I think by this he means that when the skin stretches after the FUT strip is removed, the skin stretches so uniformly that you don't need very many grafts there to keep coverage. While in FUE, you hand pick grafts so non-uniformly that you cannot take so many. This makes sense, and perhaps is true.

 

But Dr. K once gave a theory on this that made no sense at all. He called it the stretching/gliding issue. A model will explain. Assume a 1/2 inch strip is removed, and the one inch above and one inch below stretch to fill the half inch gap. So the upper one inch starts at 1 inch and stretches to cover 1.25 inches. Now break up the original one inch into ten separate regions, with region 1 being the highest region.

 

Region 1 starts at .1 inches and stretches to .125 inches.

Region 2 starts at .1 inches and stretches to .125 inches, but it also glides .025 inches to accommodate the stretch from region 1.

Region 3 stretches .125 (as do all regions) and glides .050 inches to accomodate regions 1 and 2.

Region 10 stretches 9 times .125 inches, or 1.125 inches.

 

Now, Dr. K said you get free density from the gliding, but it seems to me that he misunderstands. The glide of one region does not result in a loss of density in that region, but there is a loss in a higher region. So no, 1 +1 does not equal 2 and you cannot get more grafts from FUE instead of FUT.

[KO]

You gave another reason why American physicians may not be so enthusiastic about FUE. It is laborious and maybe not overly profitable for them. And they can't increase their rates beyond what they are to make up the difference because they would become completely uncompetitive with FUE docs in Europe.

 

I doubt someone as conservative and forthright as Bisanga would consider FUE a viable practice if he ever lost so many donor grafts.

Also, in the US, technicians cannot extract grafts, so that is I feel the main reason for FUE's lagging popularity (among surgeons). Elsewhere in the world, techs extract and surgeons implant. This is why ARTAS will probably see good growth and surgeon driven FUE is going to continue to be signficantly expensive.

[1966kph]

DR Karadeniz to your knowledge has there ever been a study into the following question?

 

A patient goes for fut having previously had fue when the strip has been removed has it ever been noted how many of the strips follicullar units had been damaged or transected by the previous fue procedure?

 

In the below link provided kindly by 1978matt Dr. Sanusi Umar talks of his findings when trying to do fue on the most challenging of hair types [African american] he states that one patient had a bad transection rate of 60% with conventional fue tools but that equipment he had a hand in the design of is producing transection rates of less than 10%.

The link is a must read for all of us who wish to educate ourselves. thank you 1978matt

 

Highlights from the 2014 ISHRS (International Society of Hair Restoration Surgery) Scientific Meeting in Kuala Lumpur, Malaysia | Hair Loss Q & A

Most dr's claim low transection rates as does i'm sure does dr karadeniz but i think he is being a bit of a scare monger for whatever reason in regard to fue.

Here is a current case on the forum of why people go for fue rather than play the FUT SCAR LOTTERY-it could be you!

 

http://www.hairrestorationnetwork.com/eve/177864-what-happens-when-donor-site-left-open.html

 

As KO stated above we need to see evidence to back up the figures being stated by dr karadeniz if we are to pay any heed to them being factual..

 

Have a good day all

[1978matt]

Some comments.

 

6000FUE and not starting to look thin is somewhat optimistic. The threshold seems to vary between 3000 - 6000 with an average of 4000. Of course, there will be exceptions where you can get away with 8000. It depends on a persons density and how easy it is to extract follicles.

 

Dr Karadeniz has been consistent throughout. He has always said that (in general) if you want the most lifetime hairs it is better to start with FUT then switch to FUE.

 

The basic, and hopefully most understandable reason is that it allows 100% of the strip area to be taken before it has been punched full of FUE holes. It allows you to get the maximum graft availability from the strip area as it's more easy to microscopically dissect a strip into follicular units than it is to punch hair out using FUE.

 

You cannot avoid damaging some follicles through FUE. Have a look at the picture I've attached. The green, blue and red lines illustrate where a punch could be driven in an attempt to extract a follicular unit. Notice how the hair at skin surface level is grouped together and yet under the surface it splays out in random directions? Note the yellow arrows showing follicles that are perilously close to being sliced through.

 

Unfortunately this randomness is what leads to the damage, especially if the procedure is rushed.

 

Here's an example of someone who was recommended not to continue with FUE:

 

http://www.hairrestorationnetwork.com/eve/170591-uk-ottawa-few-days-rahal-2000-grafts-fut.html

 

You only need to read the first page!

 

 

 

 

 

There is one issue that Dr. K has not explained much or any.

 

First lets take all the bad doctors out of the equation and bad techs who waste grafts so they can work fast. Let's assume you go to a good FUE doc.

 

Now, second you have the FUE loss issue that a second FUE wastes more grafts than the first FUE. This is because the first FUE causes scarring, which complicates the second FUE.

 

Let us take factor two out of the equation by considering someone doing a first mega session FUE like 6,000 grafts, or alternatively doing less, but totally depleting one donor area of harvest-able grafts, such that it retains only the coverage it needs to keep from looking sparse, and will never be touched again, with later FUE's being done on different donor areas. Now there is no scarring second FUE issue.

 

So with these factors out, why is Dr. K still saying that you can get more grafts by FUT instead of FUE.

 

Now, Jojotronic said there is a reason that is hard to understand. He said it was "qualitative" and not "quantitative." I think by this he means that when the skin stretches after the FUT strip is removed, the skin stretches so uniformly that you don't need very many grafts there to keep coverage. While in FUE, you hand pick grafts so non-uniformly that you cannot take so many. This makes sense, and perhaps is true.

 

But Dr. K once gave a theory on this that made no sense at all. He called it the stretching/gliding issue. A model will explain. Assume a 1/2 inch strip is removed, and the one inch above and one inch below stretch to fill the half inch gap. So the upper one inch starts at 1 inch and stretches to cover 1.25 inches. Now break up the original one inch into ten separate regions, with region 1 being the highest region.

 

Region 1 starts at .1 inches and stretches to .125 inches.

Region 2 starts at .1 inches and stretches to .125 inches, but it also glides .025 inches to accommodate the stretch from region 1.

Region 3 stretches .125 (as do all regions) and glides .050 inches to accomodate regions 1 and 2.

Region 10 stretches 9 times .125 inches, or 1.125 inches.

 

Now, Dr. K said you get free density from the gliding, but it seems to me that he misunderstands. The glide of one region does not result in a loss of density in that region, but there is a loss in a higher region. So no, 1 +1 does not equal 2 and you cannot get more grafts from FUE instead of FUT.

[hadenough2014]

1978Matt - It is hard to argue with those results for Slickers. Most people just don't give a damn about a well-hidden scar in the back when the front looks that good. While I am an advocate for FUE in certain cases, I have just seen so many good FUT cases (usually large ones) that seem to result in a much better yield (1978Matt's rock star results included) while also preserving donor.

 

I wish everyone well in making their own decision for their specific desires and risk appetite, and this debate, while heated at times, still helps people a great deal.