Are some people choosing FUT for lack of intelligence?

[Spanker]

 

 

[Spanker]

imgur: the simple image sharer

imgur: the simple image sharer

[Spanker]

Above is an example of how one would get 2800 additional grafts by going the combo route despite harvesting 30 percent density for the strip patient and 40 percent for the fue only patient in order to account the slight reduction of follicle per cm2 after a strip scar.

 

Of course, there will be some that will punch holes in this, but if you are sincerely asking a question, here is your answer. If you still can't understand that, I would argue that you are likely not a good candidate as it is doubtful you could be asked to reasonably understand the risks of ht's or be reasonably expected to have realistic and attainable goals.

 

I'm not trying to joke or be mean, I just think if this is actually not understandable to you, you may want to reconsider your options.

[GoForIt]

Nice pictures Spanker - though I think you should have gone with crayon! :cool:

 

the 3K difference by combining the approaches is huge in terms of coverage - that would be an additional 60 CM2 at 1/2 density (~100 vs. ~160 cm2 covered) - more if you had lighter coverage towards the back.

 

While the math is on - I think in practice most people would get a bit less than 2.4K grafts after being stripped out, but the pictures really show the idea well.

 

I think people forget the goal is maximum coverage with as natural look as possible, not to have a particular type of operation.

[olmert]

Spanker, explain to me your logic in assuming you can do 30% FUE harvesting after the FUT, and keep the same donor density that you would keep if you did 40% FUE without FUT.

 

In the strictly FUE case, and in the combo FUE/FUT case, the surface area of the donor region is the exact same afterward. So the ultimate density of the donor region is exactly proportionate to however many grafts you took out, no matter by FUE or FUT.

 

To put it another way, you would have to take much less than 30% FUE after the strip to keep the same donor density than you would for 40% FUE without strip. By taking the 6K grafts from FUT and stretching the skin, you essentially already did an FUE of 6K/14K = 43%. Afterward the area has only 57% of what it started with. If you then do FUE and take out another 30% of the remaining 57%, then you only have 40% ( = 70% X 57%) of the density you started with.

 

So in sum you are saying the combo is the equivalent of doing an FUE that removes 60%, and any pure FUE would probably only remove 40%. Therefore you get more by doing the combo.

 

This is more 1 + 1 = 3.

[KO]

Yes, 30% seems to be the max on a virgin scalp...30% off a depleted post FUT would be too much. But then again 40% FUE on a virgin scalp is also on the high side.

[Spanker]

Yes, 30% seems to be the max on a virgin scalp...30% off a depleted post FUT would be too much. But then again 40% FUE on a virgin scalp is also on the high side.

 

This is just examples but still giving the fut 25 percent more harvest. A person with great original density may be able to get 30 and 40 percent harvests respectively.

[olmert]

This is just examples but still giving the fut 25 percent more harvest. A person with great original density may be able to get 30 and 40 percent harvests respectively.

 

I find it extraordinary that Spanker still misunderstands that an FUT/FUE can take more grafts than a series of FUT's. It doesn't matter what density the patient starts out with.

 

In the mind boggling example he gives first he says the FUT takes 43% of the grafts from the donor region. Then he says you can have FUE take an additional 30%. Meanwhile he says if you skip the FUT, and do only FUE, you can only take at most 40% of the hair. How exactly can you only take 40% with an FUE, while you ca take 43% with FUT (and then even an additional 30% with FUE).

 

Then he says it depends on how much density the donor originally has. No it doesn't. No matter what original density, it makes no difference how you take hair out, whether by FUE or FUT. Regardless, you can take the same amount out.

 

And you will not get more grafts from and FUT/FUE combo rather than a series of FUE's.

 

To sum up, 1 FUE and 1 more FUE will give you two grafts. 1 FUT plus 1 FUE will give the same two grafts. One plus one will not equal 3.

 

And Dr. Karadeniz's math is no better. His bunching up (or excess) skin theory makes no sense. If an inch wide strip of hair containing 500 follicles is bunched up so that it is only 1/2 and inch wide, then the hair will be twice as dense. It will look twice as dense. Stretching it out to one inch wide will return it to half as dense. Again, one plus one will not equal three.

[Spanker]

The vast majority of the posters in the 2 threads you've posted about this agree that you can get more using the combo method, so I really don't understand why you would says it's extraordinary that I disagree with you? The evidence shows by the number of people who disagree with you, which is irrefutable and in black and white, go back and count them if you like, is that you should look at it as completely ordinary, as opposed to extraordinary. With all of the people, including a physician, the board's biggest fue proponent, myself, and several other accomplished posters with thousands of posts and thousands of hours of research, who have had surgeries and have years of experience under their belts, is there something special about you that separates you from the 80 or 90 percent on the respondents not agreeing with what you're saying (actually, I don't know if anyone has come flat out and agreed with you)? Is there something that you know that we don't? Is there some kind of experience that you have that sets you apart from the people who grasp this concept?

 

I don't understand why you are calling individuals out when hardly no one agrees with you, they were just smart enough to not come back to this thread.

 

Again, this makes disagreeing with your concept the very opposite of extraordinary.

[olmert]

is there something special about you that separates you from the 80 or 90 percent on the respondents not agreeing with what you're saying (actually, I don't know if anyone has come flat out and agreed with you)?

 

 

Yes, there is. I am a math guy. And having read all the reasonings given, I can say these reasonings are based upon misunderstandings of math, which is a very common phenomenon. One thing I can tell you is that, if your claim is true, it is not for any of the reasons given

 

Dr. Karadeniz might be a great surgeon, but he is not a mathematician. And his reasoning makes very clear that he does not understand the math here. For most everything in surgery, higher math will not help and a fourth grade understanding is all that is advantageous. In short, you can believe that in some circumstances 1 + 1 = 3 and be the best surgeon in the world.

 

And Spanker’s reasoning is the same 1 + 1 = 3.

 

It is very common in the world for people smart in some areas to have a mathematical blind spot.

 

Most of the world doesn’t understand the mathematics behind why raising tariffs makes a country poorer, when the tariffs give more tax money taken in part from foreigners.

 

And here too a group consisting of FUT believers gives reason after reason for why the FUT/FUE combo gives more grafts. And each reason given is another form of 1 + 1 = 3.

 

And I do suspect, if the claim were true, someone would have a reasoning to give that is not based upon mathematical misunderstanding.

[Rootz]

I would think a FUT strip lowers the density of all nearby hair, but does so in a way that is more uniform and therefore subtle. When the skin is pulled together the surrounding skin is stretched out. The stretched skin should bounce back a little (in part to the scar stretching), but the overall density is still lower because there's less hair over the same surface area.

 

When the skin is stretched all hairs are being pulled away from each other in a relatively uniform fashion. Imagine if in FUE instead of plucking out entire grafts, they were all just spaced out ~10% more. The result is a very "natural" reduction in density as there are no holes or gaps (except for the giant scar itself lol).

 

I would think the same amount of grafts are harvestable with either FUE or FUE+FUT, but what it come down to is do you want a giant scar or possible a moth hole look? To me it makes more sense to push the boundaries with just FUE exclusively, and use FUT as a last resort. If you think about it, FUT leave a giant section of 0 density across your scalp... it's called the linear scar itself. So IMO the benefit you get from uniform density reduction is more than offset by this problem.

[hairweare]

I would agree with Rootz's reasoning provided the surgeon has the technical and artistic skill to skillfully extract the grafts in a diffuse pattern that disguises the subsequent thinning. Less contrast between the recipient and donor areas if done well will serve to enhance the illusion that the HT is entirely natural appearing. Not only did I not like seeing the linear scar after a short haircut, but the persistent feeling of tightness is something you eventually deal with but it never truly goes away completely.

[Shampoo]

the persistent feeling of tightness is

something you eventually deal with but it never truly goes away completely.

 

hairweare who did your surgery?

 

i have had two FUT procedures and have ZERO "feeling of tightness".

[olmert]

I think tightness largely depends upon the patient's low laxity. I have tightness after just one FUT of 2100 grafts.

[Blake Bloxham]

It will be interesting to see how the "combo" procedures plays out. While I understand the logic of maximizing grafts, I still think most would probably either:

 

a. Start with strip (for whatever reason) and undergo multiple strip procedures until they are satisfied

 

b. Start with FUE (for whatever reason) and undergo multiple FUE procedures until they are satisfied

 

c. Start with strip, undergo several strip procedures, realize they may be able to obtain some additional grafts via FUE far down the road, and utilize these instead of undergoing another strip surgery on, what is likely, a tighter scalp.

 

Despite the potential for maxing out the number of grafts, I think we'll continue to see more and more bigger FUE procedures and more patients undergoing multiple FUE procedures to achieve desired results.

[LondonHT]

hairweare who did your surgery?

 

i have had two FUT procedures and have ZERO "feeling of tightness".

Agree, must just depend on the person.

[scar5]

 

c. Start with strip, undergo several strip procedures, realize they may be able to obtain some additional grafts via FUE far down the road, and utilize these instead of undergoing another strip surgery on, what is likely, a tighter scalp.

/QUOTE]

 

..and then lose the more hair as the effectiveness of Fin wears off, try your buzz your hair, and see the terrible strip scar, grow it back, hope for the best, realize the fantasy and that the joke is on you, buzz it again, looks even worse, grow it out again, seek out FUE in a desperate last ditch effort (because you can't do the dignified shave) , hope for the best again, and realize that strip surgery is for lucky guys.

 

Strip is big business. For two decades it has paraded its massive results. The losers, and there are many more than the winners, don't know, wouldn't bother, have given up, realize there is more to lose than gain etc... don't pore to the pond.

 

I recommend doing FUE and as much medication as you can tolerate before deciding to incriminate yourself with an ear-to-ear strip scar. (I don't car if it is "pencil thin" and 1mm, I will point it out to the girl you are courting if we ever meet.

[Spanker]

(I don't car if it is "pencil thin" and 1mm, I will point it out to the girl you are courting if we ever meet.

 

Well...that's kind of jacked up, and a good way to be get a dentist or an emergency room pointed out to you if you were to do it to the wrong person for not minding your business.

 

I understand that you have contempt for strip surgery because apparently you received poor results, but I don't understand disrespecting those that have chosen it, like yourself. Especially in public.

[irishsailor]

I recommend doing FUE and as much medication as you can tolerate before deciding to incriminate yourself with an ear-to-ear strip scar. (I don't car if it is "pencil thin" and 1mm, I will point it out to the girl you are courting if we ever meet.

 

 

See no need for that comment. I've had both type of surgeries and both have there place.

 

But your an idiot for that comment,

[Shampoo]

Well...that's kind of jacked up, and a good way to be get a dentist

or an emergency room but I don't understand disrespecting those that have chosen it, like yourself.

 

It appears there are few FUE "control freaks". They think they know what's best for everyone else. They know better than you do what's best for you! They know more than many higly respected doctors. It doesn't matter if you have carefully studied the pros/cons of each type of procedure and arrived at a different conclusion.

 

The doctors doing FUT are all crooks, greedy, lazy, and/or unskilled. The doctors doing FUE are great guys.

 

And hey if you decide FUT is a better fit for you then you just may have a "low IQ" or there is possibly something sinister going on like working undercover for a clinic that utilizes FUT. It's amazing to watch "my way or the highway" rationale and the need to control other people. Why not decide what's best for you and let everybody else do the same without the insulting remarks?

[JoeTillman]

There are a few problems with the answers because there are problems with the question. FUE will give a patient FAR more grafts over multiple sessions than strip or a combination of strip and FUE. There is NO way to dispute this. Just ask this guy...

 

 

In all seriousness, every hair in the donor zone, outside the donor zone, the ears, the nose etc. can be extracted via FUE and placed into the target recipient area. Thirty thousand, fifty thousand, seventy-five thousand grafts (?) can be moved if the patient has them to accomplish their goals but at what cost ( cosmetically )? The whole point of having any cosmetic procedure is to achieve the desired outcome with no evidence of the procedure having been performed to begin with. This is where the answer will be different for every patient.

 

*NOTE* With each point below keep in mind that the scenario assumes that we are trying to avoid the cliche'd "moth eaten" appearance.

 

In my own case, I could never achieve the results I have been blessed with by FUE alone. No way, no how. I've had seven strip surgeries...

 

1.) Mini-micro grafts, 300 to 400 grafts, Dr. Norris.

2.) Mini-micro grafts, 300 to 400 grafts, Dr. Norris.

3.) FUT - 2406 grafts, Dr. Wong.

4.) FUT - 2425 grafts, Dr. Wong.

5.) FUT - 2488 grafts, Dr. Wong.

6.) FUT - Scar revision - 144(?) grafts, Dr. Wong.

7.) FUT - 1399 grafts, Dr. Wong.

 

Add it all up and I've had nearly 10,000 grafts transplanted via strip alone. This, from a donor zone that had moderately fine hair, average density and in a hair loss pattern between a NW6 and a NW7. At this point I can have haircuts as short as a #3 guard due to the nature of the donor scar and no one on the street would suspect that my hair is unusual in any way much less would they think I've had seven surgeries on my head.

 

At this point in the game, should I ever decide to have more work, I *could* have more strip on the sides but I would not get over a few hundred grafts and it would also risk widening the scar which I'm currently very happy with. FUE is the only way I will ever consider having more work and it would allow me to have, most likely, in the neighborhood of 1500 to 1800 more grafts from head hair alone. I am the perfect example of how a combination approach will afford me the ability to have more hair than I would get from strip alone. This does not include the option of utilizing body hair or beard hair which is another discussion entirely.

 

Now, consider how much scalp tissue was removed from my procedures. Dr. Wong and I actually calculated this based on my charts and by estimating how much was taken by Dr. Norris back in the early 1990's. Dr. Wong and I concluded that my donor scalp has had no less than 6 cm of tissue removed. Again, this was from a donor zone of a patient with a pattern of loss between a NW6 and NW7.

 

You can see my donor zone, before I ever set foot in the clinic of Hasson & Wong, in the photo below which was taken nearly fifteen years ago.

 

 

Here is a photo I took this morning, with a ruler, to show how the donor zone measures out. In this image, it shows that my safe donor zone is approximately 3cm wide at the back. I uploaded an image nearly 5mb in size so you can enlarge it for a better view.

 

 

And here is a rough side by side comparison, fifteen years and seven surgeries apart. My hair is now much shorter but I don't have two wide donor scars to hide any longer:)

 

 

Notice that there is not a big difference between the overall surface area of my crown border and the donor zone. The comparison is not perfect but I think it is easy to see that my donor zone does not appear to be showing a deficit of a full 6 cm. How can this be??? It is not something that can be explained by linear theories on elasticity (Hooke's Law) as we have to consider the mechanics of skin expansion.

 

Skin expansion is what happens when you remove one or multiple strips. Remove a strip, pull the upper and lower edges of the wound together, suture or staple and you have tension that is spread out above and below the incision wound. When skin is put under sustained tension it activates mechanotransduction pathways which leads to cell growth and the formation of new cells in the skin tissue. Quite literally, new permanent skin is formed and it eventually lessens the tension from the initial strip excision. This is the same process behind balloon expansion treatments. It does NOT however produce more hair. The spaces created between the remaining hairs of the surrounding scalp tissue (due to the initial stretching of skin to close the gap created by the strip removal) are lessened as the tension is reduced due to the new tissue formation. This allows for a more uniform density throughout and an eventual reduction of "gaps" between hairs that may be more evident immediately post-surgery. My donor density is certainly lower than it once was but the reduction in density is NOT on a one to one ratio. Far from it actually and when the hair is lifted the density does not appear to be reduced as much as one would assume if they do not understand the mechanics of skin expansion.

 

Had I been in a position to have high yield FUE back in March 2002 (my first sx with Dr. Wong) and have multiple subsequent high yield FUE procedures many of the grafts would be taken from outside of the safe strip donor zone but not outside of the safe FUE donor zone. The two are not synonymous. I would have hair taken from below the strip zone, above the strip zone, higher up, but not into, my parietal humps (as mine are gone) and further forward into my temple points. However, because the density is reduced on an exact one to one ratio my overall density would be VISIBLY lower. There is no way I could have nearly 10,000 grafts removed via FUE without having a noticeably thinner donor zone.

 

For many years when someone would ask me or Dr. Wong why I was able to continuously come back for more surgery the answer has been, simply, that my laxity keeps returning, but in reality the real answer has been more complicated in that enough new tissue was being generated from each prior procedure that it would allow enough laxity to return for subsequent procedures. Most people do not have this option as their scalps will be tight after one or two surgeries of moderate size and to continue to have more strip will jeopardize the strip scar. THESE are the types of patients that would benefit more from an FUE only approach in order to get the most grafts (if it were one procedure vs. the other) but of course this greatly depends on the density of the donor zone and the size of the target recipient area.

 

In the end, arguing about which technique will yield the most grafts in multiple procedures is secondary to what the patient wants to deal with as a consequence of surgery, or it should be. Have they sworn off head shaving and want to gamble on doing anything and everything to get as much hair as surgically possible? There are options in FUE, FUT or a combination of the two with FUT being first and FUE being the secondary adjunct for maximum graft harvesting. The same goes for those that have already had strip, have a tight scalp because of it but still have ample amounts of donor hair remaining. There are also the patients that are going to stress over having even the thinnest and finest of donor scars regardless of how great the final result is. There is one option for them and that is FUE because in the end, if the donor scar is a big deal to the patient, the result of growth could potentially be overshadowed no matter how great it may be. This may mean fewer grafts if only scalp hair is utilized but for many the trade-off is well worth it.

[haircut]

Wow. Great explanation!

 

The best contribution is your explanation of laxity.

 

Thanks so much Joe!

[KO]

 

And hey if you decide FUT is a better fit for you then you just may have a "low IQ"

 

Ironic you say that because Dr Karadeniz suggested that those who seek Strip have higher intellectual abilities....I get his point...but you could do the same.

[KO]

This allows for a more uniform density throughout and an eventual reduction of "gaps" between hairs that may be more evident immediately post-surgery. My donor density is certainly lower than it once was but the reduction in density is NOT on a one to one ratio. Far from it actually and when the hair is lifted the density does not appear to be reduced as much as one would assume if they do not understand the mechanics of skin expansion.

 

 

 

Thanks for the post. Could you clarify the bolded? How could reduction in density not be one to one?

[Shampoo]

Ironic you say that because Dr Karadeniz suggested that those who seek

Strip have higher intellectual abilities....I get his point...but you could do the same.

 

I didn't see that....

maybe he was being sarcastic or "counter-punching"

but who started this insulting TRASH thread?

Not Dr. Karadeniz!