Are some people choosing FUT for lack of intelligence?

[olmert]

Joe Tillman writes: "If the patient wants the most grafts at once and has an advanced pattern of balding, doesn't ever want to shave and understands the risk then he'll choose strip."

 

This is a vey confusing statement. Why does Joe add in the words "at once," which hedges the declaration? Doesn't Joe believe that you can remove the words "at once" and the statement remains true. This is to say, doesn't Joe believe believe whether you want more grafts at once or want more grafts after all surgeries, you cannot do FUE?

 

 

KO writes “While I agree that FUT does not deplete density visibly due to the reasons JoeTillman explained, the line coming from clinics and posters in the past was that density would be unchanged after a strip, and that is the reason that many on the forums get irritated.”

 

Are you referring to Joe Tillman’s explanation for why the same number of grafts taken by FUT will not make the donor area as bald as would if taken by FUE. This explanation, Joe said, is hard to visualize, but relates to new skin forming to fill in the holes caused by the FUT stretch. It is certainly hard to visualize because at least ostensibly the hair would seem to cover whatever happens to the skin. Are you saying you disagree with this explanation and further do not believe that hair taken via FUT reduces donor density less than if taken via FUE, and further someone seeking to maximize total lifetime grafts transplanted cannot do it with FUE alone, without FUT? (You are likely aware Spanker, Joe Tillman, and some others have argued otherwise.

[scar5]

KO is wrong if he believes that, same as Spanker and Joe etc.

 

The FUE holes and scar are due are irrelevant to the equation. If you read my earlier post, you know why.

 

Strip clinics have tried to bluff us for years that donor density wasn't depleted like FUE. Actually, tried no, DID bluff us, because nobody blinked. As late as June/July people on this board were arguing against it.

 

Only in recent months have they had to concede ground on the stretching issue (that yes, in fact, strip stretches out the scalp) and that has been only die to people like us banging on about it.

 

Next, you need to bring up linear incision transection. Joe addressed that in his last post, but there is no doubt loss.

 

In the last post Joe mentions that when bundles shed a single hair, FUE transection rates go up. He doesn't mention that these bundles will also be misidentified in strip dissection too.

 

I don't know about the ARTAS robot. Does it have a rotating chuck? So that various diameter punches are automatically rotated to extract various sized bundles it has identified? Does it even know the bundle size? Or does it just see a blob and then make a judgment based on the color density of that blob? Perhaps it is one-size-fits-all?

 

People don't choose strip for the reasons Joe suggests, IMHO. They choose it because they are told to do it by a strip clinic.

 

It is not just the linear line. It is the buckled scalp too and the prospect of having to undo all the 'good work' a second or third time for successive strips. Then there is the big question, if no drugs - no hair - no exit etc.

[JoeTillman]

Hey there Joe. I'm quite sure we are talking about the same thing. I said 10-14% of all single-hair grafts are invisible and thus discarded(the singles in the strip). Whilst a lower figure for the 2 hair grafts(due to the lower chance of both HAIRS being dormant and thus invisible) being discarded and an even lower chance for 3 and 4 hair grafts. I did not state 10-14% of all grafts were discarded though. That is what is often believed. If someone had 100 single hair grafts in his strip zone(dormant or live) then 10-14 would be dormant and invisible. Hence discarded. I think we mean the same thing.

 

I think we are as well but I think that it is a lower number of hairs discarded because the hairs in telogen (10% to 14%) are distributed through all of the follicular units regardless of the number of hairs in each grouping. For every 100 hairs (some are part of multi-hair FU, some as single hair FU) as many as 14 will be in telogen but because single hair FU's make up no more than about 25% of all FU's on the scalp we have to apply the maximum 14% to that specific subset. As you said, the loss of a single hair to telogen in a multi-hair FU means that the FU will not be discarded. Since it is only the single hair FU's that are discarded due to telogen making them invisible the number drops to 3.5 on average per 100 hairs harvested. This means that for every 1000 grafts we are looking at 35 hairs and for every 4000 grafts we are at 140. I hope this makes sense.

[JoeTillman]

I understand what you mean Joe, I hope it grows in popularity due to its results and not its marketing or cause its an easy solution for doctors who can't perform FUE manually.

 

In the end its all about the results, if we see it perform we will al be cheering. I heard the radio show you sounded pretty confident about it, i hope its as good as it sounds!

 

I'm cautiously optimistic about it because I recently learned how it, well, learns. The progression of it's efficiency and abilities is fast and it is only getting better each day. I know the company that builds it is working on making it viable for more types of hair types and they are working on smaller punches. My observations tell me that Restoration Robotics really wants it to be more than a sideshow act. This doesn't mean I'm confident in it now, just in how it is evolving.

 

What I do not like about it is that in five years going to a hair transplant clinic will be no more involved than going to the dentist. I say this because there will be little for the patient to review to distinguish between one clinic and the next if they both use the ARTAS and with the fact that it will be performing the placement at some point as well then the specialization of hair restoration will be about as specialized as a computer tech. People will be doing their research on Yelp, lol!

[JoeTillman]

Olmert,

 

Joe Tillman writes: "If the patient wants the most grafts at once and has an advanced pattern of balding, doesn't ever want to shave and understands the risk then he'll choose strip."

 

This is a vey confusing statement. Why does Joe add in the words "at once," which hedges the declaration? Doesn't Joe believe that you can remove the words "at once" and the statement remains true. This is to say, doesn't Joe believe believe whether you want more grafts at once or want more grafts after all surgeries, you cannot do FUE?

 

"At once" meaning in one procedure. I wasn't hedging anything, you're just over analyzing my words:)

[Spanker]

I'm not big in ARTAS as of right now. I have to see more results. As of now, as far as I know, it's just for extractions. If it's that good at extractions, great, but as I keep saying, it's only part of the equation. Put a thousand good grafts in front of one great doctor and you won't get the same outcome as a thousand good grafts in front of another doctor that can afford an ARTAS system. If I start seeing more impressive results from ARTAS, I'll change my mind.

[Noodles123]

I think we are as well but I think that it is a lower number of hairs discarded because the hairs in telogen (10% to 14%) are distributed through all of the follicular units regardless of the number of hairs in each grouping. For every 100 hairs (some are part of multi-hair FU, some as single hair FU) as many as 14 will be in telogen but because single hair FU's make up no more than about 25% of all FU's on the scalp we have to apply the maximum 14% to that specific subset. As you said, the loss of a single hair to telogen in a multi-hair FU means that the FU will not be discarded. Since it is only the single hair FU's that are discarded due to telogen making them invisible the number drops to 3.5 on average per 100 hairs harvested. This means that for every 1000 grafts we are looking at 35 hairs and for every 4000 grafts we are at 140. I hope this makes sense.

 

This is such an excellent explanation. Joe, you really have a talent for putting technical concepts in plain English and for responding to arm chair experts.

[hadenough2014]

I am sure that pretty soon we will be seeing FUE robots in strip clinics cause you can't teach an old dog new tricks. The tide has changed, most patients simply don't want to suffer a procedure like this for hair especially when they see the same or even better results from FUE...

 

This whole discussion/thread centers on part A, and I think what we need to focus on is part B. Part A is extraction, yield, and placement and Part B is survival and growth. Neither procedure is worth the psychological and financial investment if the growth and result desired is not there. The real question should center on which procedure results in a higher degree of successful growth. Is there enough evidence to answer that question? Perhaps not, but some studies show FUT has better survival rate. If I was a young man who wanted to wear my hair short, and I was told that FUE will allow me to do that, but there is chance that 30% fewer grafts will survive and grow due to the trauma of the extraction method compared to FUT, would I proceed with the surgery? I understand advocates of FUE for reasons of wearing hair short, but I have also seen some modern FUT scars that, when treated with FUE or SMP during a later procedure, become undetectable with a clipper 1 or even a shaved head. So the scar became a non-issue/non-concern for me personally when making my decision. Survival and growth was paramount.

 

So do all the math you want about yields and donor areas that seem (to me) so very close in comparison, but survival rate and growth are my focus. Some FUE patients may have had great results for whatever specific reason, but I was not willing to take the chance that I go through all this and get a poor survival rate and end up unhappy with the result. It made sense to me that the FUT method has a higher survival rate due to less individualized trauma on the grafts.

 

I think FUE will continue to grow in the industry to make hair transplantation more affordable and attractive to younger people, resulting in a cycle of multiple procedures over a lifetime, never really exposing their MPB. FUT should continue to be attractive to folks like me who need one big session and want maximum survival. I would like to see the industry issue a comprehensive study on FUE vs. FUT, with special focus on survival rates, but I doubt that can objectively happen now since camps for each have been firmly established, as demonstrated by this thread and the ongoing debate.

[scar5]

I would like to see the industry issue a comprehensive study on FUE vs. FUT, with special focus on survival rates, but I doubt that can objectively happen now since camps for each have been firmly established, as demonstrated by this thread and the ongoing debate.

 

I don't think the camps are established.

 

It's a fluid situation as more and more clinics and patients move from strip to FUE.

 

Just 5 years ago, most people here said FUE is for small jobs.

 

Even three years.

 

What we have is inertia based on patient choices. People chose strip or chose FUE and then dug in their heels to defend their choice. But there is a lot of migration to FUE actually going on regardless.

[Number47]

For me there are two worlds in HT industry the forums world and the real world.

 

Personally i think that things have changed a long time now. The only thing that was keeping strip alive was not the better results of strip Vs FUE. Strip was kept alive, and on top, thanx to one clinic only.

 

It was H&W with these unique megasessions of 6-7-8.000 grafts at one pass! People were drooling over these cases and were opting for strip thinking they can get just that if they are lucky or if they perform these scalp "jelging" like exercises .

 

You were suddenly seeing great results with the help of propecia and avodart so things don't go south later on and huge strip scars going pass the ear almost as close as the temple!

 

 

Somehow these cases have stopped we don't see much of that now, i don't know what happened there... but something happened on the FUE field,suddenly we were seeing megasessions FUE!

 

From that point on, and when FUE showed that it can do what strip does without the hustle, the scars and the risks associated it was all a matter of time.

 

There is one variable far more important that the debate we are having here about graft numbers. Hair surgery is not like other cosmetic procedures if things go wrong its up there sitting as a crown on your head for everyone to see. And things can go wrong with any doctor being strip or FUE. And we only have one shot to get this thing right. If the first procedure doesn't work unfortunately the grafts can not be replaced since we have a short supply.

 

And history in these forums has taught us that things can go wrong more often than clinics would like to admit,even from the best, no matter the method we chose. Its the procedure with the easiest exit strategy that must prevail. Cause even more important than getting our hair back is not becoming a "freak" in the process. Buzzing down the hair to make it invisible to the eye its an EXIT strategy! Its the same exit strategy balding people all around the world who lost the battle against hairloss use, when the drugs failed, when the side effects creeped in, when they said enough is enough i need a peace of mind.

 

Strip makes that exit strategy nearly impossible with the frankenstein scar, especially if you were one of the megasessions!

Edited November 17, 2014 by Number47

[hadenough2014]

Strip makes that exit strategy nearly impossible with the frankenstein scar, especially if you were one of the megasessions!

 

 

Ok, fair enough. You are focusing on exit strategy in the event of massive HT failure. But I do not think you are giving enough credit to modern closure techniques that top FUT docs use. There are closure horror stories for sure and you can see terrible scars on the internet from bad docs all across the world (many of which were done 10-15+ years ago as well), but the Tricophytic donor closure method, when executed in the hands of an experienced surgeon, can result in undetectable results. Hair grows THROUGH the scar! SMP can help further if necessary. Hiding a scar is an art that has been nearly perfected as well, so that part of the "exit strategy" was not a concern for me, as I chose an experienced doc who uses the Tricophytic donor closure method and respects my level of laxity.

 

HT is not a place to try and use a coupon or get a discount - always go with the doc and procedure you feel will give you the absolute best results, and then just be prepared to pay the price and do it right. Some of these horror scars you see on the internet are likely from butcher docs who have no business doing HT in light of today's modern FUT techniques they do not care to employ or understand.

 

By the way, FUE can also go bad and ruin your exit strategy theory. Google "FUE bad results in donor area" and you can find some horror stories as well. Moth balls and pitting are possible. Who knows, some of these patients may have gone out and gotten drunk the night before surgery and bled like a stuck pig during the procedure, and those patient responsibility factors need to be considered, but FUE is not done without risk.

[JoeTillman]

Scar5,

 

Strip clinics have tried to bluff us for years that donor density wasn't depleted like FUE. Actually, tried no, DID bluff us,...

 

There was no bluff. FUT doesn't thin out the donor the way FUE does. Period.

 

Next, you need to bring up linear incision transection. Joe addressed that in his last post, but there is no doubt loss.

 

In the last post Joe mentions that when bundles shed a single hair, FUE transection rates go up. He doesn't mention that these bundles will also be misidentified in strip dissection too.

 

Because it is not so much of an issue for properly performed FUT. For the longest time you and others have talked about how much destruction goes on when a scalpel is used to remove a donor strip but you don't understand the mechanics of how the process works. It makes sense on the outside, but the truth is more involved.

 

When a strip is properly excised the donor zone is first tumesced with saline. This causes the target area of the donor zone to inflate like a balloon and become turgid. It is very firm, almost hard, to the touch. The distance between follicular units is expanded considerably to at least double the normal distance of 1 mm to 1.4 mm. There are already existing patterns for how follicular units are arranged in the donor zone and there are "lines" that can be followed in between the bundles. I talked about this years ago. When the donor zone is tumesced these lines become like four lane highways and the scalpel cutting edge is the equivalent of a fishing line running down the middle of this highway with LOTS of room on either side. A scalpel already has plenty of room in between bundles as the blade is 1/200th of an inch wide which is 1/13th of a millimeter. The cutting edge is far more narrow than this as well. When a scalpel is pushed through the tumesced tissue the tissue separates cleanly and predictably. In fact, when the tissue is tumesced to the right point it then starts to separate at the very beginning of the cut, when the skin is first "nicked" by the blade.

 

It is fascinating to watch and a good analogy would be comparing it to a paper cut. A papercut on your finger is difficult to see because it is so fine and the only thing that tells you it is there is the blood and the pain. Wipe away the blood and the papercut is difficult to see. That same papercut, when the tissue is tumesced underneath it, would be easy to see because it would splay open due to the underlying pressure created by the tumescence, pushing it open. The tissue is fighting to spread open and once the top layers of skin are cut the tissue below just unfolds and this spread from the pressure being released allows for the top of the follicles to be seen along with the length of the follicle. The tissue literally opens up on it's own so THIS is what prevents strip from being a blind technique and allows for an extremely low transection rate. The scalpel is pushed along on the top layer of skin tissue to "score" the path and the tissue opens up behind the scalpel, as it moves along. It is just like the wake of a boat as it travels through the water. The further the scalpel moves along the wider the spread behind it which allows for better visualization of what's going on in the lower layers.

 

With regards to actual graft dissection, it is easy to see hairs that are in telogen if they have not shed. Some clinics utilize back lighting on their dissection boards while others are adept as slivering very fine pieces of donor tissue that are fine enough to be nearly transparent. With FUE these hairs are potentially transected before they are fully extracted so even if the clinic trims their FUE grafts after extraction the damage is still done.

 

This is how it's done in better clinics, or at least some, but other clinics are more gung-ho and may not take so much care as I described but the point is, when done right, the kill rate from a strip removal is in my opinion potentially lower than the kill rate of FUE extraction. Different clinics will have different survival rates with different patients and techniques so of course the above is not anywhere close to being a blanket explanation.

 

Now, what does this academic OCD bickering mean in the end? Absolutely nothing. What matters is the aesthetic result, both in the recipient and the donor, and that the patient went into the procedure fully informed. That is my only concern.

[JoeTillman]

I am sure that pretty soon we will be seeing FUE robots in strip clinics cause you can't teach an old dog new tricks. The tide has changed, most patients simply don't want to suffer a procedure like this for hair especially when they see the same or even better results from FUE...

 

This whole discussion/thread centers on part A, and I think what we need to focus on is part B. Part A is extraction, yield, and placement and Part B is survival and growth. Neither procedure is worth the psychological and financial investment if the growth and result desired is not there. The real question should center on which procedure results in a higher degree of successful growth. Is there enough evidence to answer that question? Perhaps not, but some studies show FUT has better survival rate. If I was a young man who wanted to wear my hair short, and I was told that FUE will allow me to do that, but there is chance that 30% fewer grafts will survive and grow due to the trauma of the extraction method compared to FUT, would I proceed with the surgery? I understand advocates of FUE for reasons of wearing hair short, but I have also seen some modern FUT scars that, when treated with FUE or SMP during a later procedure, become undetectable with a clipper 1 or even a shaved head. So the scar became a non-issue/non-concern for me personally when making my decision. Survival and growth was paramount.

 

So do all the math you want about yields and donor areas that seem (to me) so very close in comparison, but survival rate and growth are my focus. Some FUE patients may have had great results for whatever specific reason, but I was not willing to take the chance that I go through all this and get a poor survival rate and end up unhappy with the result. It made sense to me that the FUT method has a higher survival rate due to less individualized trauma on the grafts.

 

I think FUE will continue to grow in the industry to make hair transplantation more affordable and attractive to younger people, resulting in a cycle of multiple procedures over a lifetime, never really exposing their MPB. FUT should continue to be attractive to folks like me who need one big session and want maximum survival. I would like to see the industry issue a comprehensive study on FUE vs. FUT, with special focus on survival rates, but I doubt that can objectively happen now since camps for each have been firmly established, as demonstrated by this thread and the ongoing debate.

 

I think you are the perfect example of why strip is a good choice for some patients. You obviously thought about the ups and downs of each procedure and you made the choice that you felt was the best one for you. The saving grace of FUE, no donor scar, was not an issue, because you have no interest in shaving.

 

But do not misunderstand today's technology vs. that of the past. Donor wound closure by top clinics is fantastic. I've certainly had my own fair share of them but there is no guarantee of a fine donor scar and the option to hide it completely with SMP and/or FUE is highly subjective. I'm basically responsible for the concept of temporary SMP in North America and I'll be the first to tell you that SMP does not always take well into scar tissue, and in fact, I think that more times than not it just doesn't work well in scar tissue at all but that is a different discussion. Tricophytic closure does not always work either in that sometimes the hair just doesn't grow through the scar tissue and other times, when it does, it does not make a significant cosmetic difference.

 

Point being, even in the best of hands strip doesn't always work out so well in the donor zone and that is why FUE is growing so fast. You went to an exceptional doctor and I'm sure you've had an equally exceptional experience but different patients will have different outcomes even when all of the indicators are a green light across the board.

[Blake Bloxham]

I'm not wowed by the highly automated machines either. I understand the urge to standardize and remove the element of fatigue and human error; however, I don't understand discarding the physician's touch and the gentle, precise nature of manual tools.

 

I've spoken with a number of physicians who reverted back to manual FUE after trying a number of these bigger machines, and they echo the same sentiments.

[hadenough2014]

Thanks for the post, Joe. All very true. Regardless of which procedure I chose, there was a certain amount of risk involved in results. I do plan to always wear my hair at a length where the scar will not be evident. I have never in my life worn it shorter than probably an 8 on the clipper guard (one inch). In fact, I've never used a clipper for a haircut - my hair is too wavy for a clipper and does not cut properly without being wet and using a scissors.

 

I certainly hope hairs grow through my scar very well and it looked like I have a good start, last I checked. In fact, I think it is about time (day 30) that I get some up-close photos of that scar to see how it's going!

[JoeTillman]

I'm not wowed by the highly automated machines either. I understand the urge to standardize and remove the element of fatigue and human error; however, I don't understand discarding the physician's touch and the gentle, precise nature of manual tools.

 

I've spoken with a number of physicians who reverted back to manual FUE after trying a number of these bigger machines, and they echo the same sentiments.

 

I agree, Blake. I've spoken to several clinics as well that have reverted back to manual or some sort of motorized punch but my particular point is that the machines, namely the ARTAS, is improving and it isn't going away and will only grow in popularity. ARTAS isn't the only robot either. There will be other offerings, and probably cheaper too, as the presence of ARTAS has made other companies aware of the potential so more are getting involved.

[Blake Bloxham]

Joe,

 

I definitely see your point. However, I still think the results are lacking and usually the "tides turn" on these types of devices. In the end, it seems like clinics buy these "latest and greatest" in cosmetic surgery/medicine, make some money from its novelty for a few years, and essentially stop once it becomes widespread and the hype dies down. We've seen it in the hair restoration field with devices like the NeoGraft, implanter wheels, "laser assisted site creation" and in other cosmetic fields with things like "cool lipo," laser hair removal, "vampire facelifts," etc. I suppose I simply don't see the ARTAS as revolutionary enough to follow a different destiny. I think people may "catch on" a bit, and it's popularity will peak and eventually decline (like the devices and methods described above). Do you really see it as revolutionary enough to differ from these trajectory?

[JoeTillman]

Blake,

 

Let me be clear, I'm not saying that ARTAS is cranking out excellent results. My point has to do with it's adoption, it's ability to learn and how committed Restoration Robotics appears to be in improving it. ARTAS is better now than it was a year ago and it was better a year ago than the previous year and it will be better next year than it is today. It is getting better all the time and it will continue to do so.

 

You make an interesting point about other devices. I think Neograft is still growing as well, we just don't hear as much about it because the controversy about it has died down online. The other devices such as the wheel and laser assisted incisions were never big to begin with in my opinion and were merely flashes in the pan.

 

Do you really see it as revolutionary enough to differ from these trajectory?

 

In it's present state? No and let me further qualify my position by saying I would not lay down for an ARTAS procedure today myself if given the opportunity. But again, my point is that it is getting better and it will be put into more inexperienced hands than experienced hands and eventually you will see more names that you've never heard of when you do a Google search for "hair transplant". In fact, that is happening right now. I don't agree with it, I just recognize it.

[Blake Bloxham]

Joe,

 

As always, thank you for the insight!

[Number47]

Ok, fair enough. You are focusing on exit strategy in the event of massive HT failure. [/b]

 

Unfortunately not my friend I am not talking about massive HT failure or a nuclear disaster on your head. I am talking about things that are common, lack of growth, unnatural looking result, drugs stop working, the patient is not happy with the density and he is all the time self conscious about it and unhappy, his supply cannot meat the demand cause his hair loss progressed passed a certain point, he had a hair transplant to early relying on drugs to keep his hair but drugs failed him or started having serious side effects.You name it there are various reasons you could regret a hair transplant sooner or later.

 

I am not talking about stretched scar or nerve damage or necrosis I am talking about an exit strategy if you are not happy with how your hair looks even though you had hair transplants. An exit strategy when you can't reach what for you looks acceptable due to various variables.

 

I know FUE is not like a virgin scalp if you buzz down but nothing can beat the smile scar! I mean it would be cool if it was a shark bite you could have a story to tell, but its just a mark of failed vanity that we could do without.

[Number47]

Joe,

 

I definitely see your point. However, I still think the results are lacking and usually the "tides turn" on these types of devices. In the end, it seems like clinics buy these "latest and greatest" in cosmetic surgery/medicine, make some money from its novelty for a few years, and essentially stop once it becomes widespread and the hype dies down. We've seen it in the hair restoration field with devices like the NeoGraft, implanter wheels, "laser assisted site creation" and in other cosmetic fields with things like "cool lipo," laser hair removal, "vampire facelifts," etc. I suppose I simply don't see the ARTAS as revolutionary enough to follow a different destiny. I think people may "catch on" a bit, and it's popularity will peak and eventually decline (like the devices and methods described above). Do you really see it as revolutionary enough to differ from these trajectory?

 

I also heard from many doctors that each patient is different. When they do FUE on you they somehow understand after the first removals how your hair responds and they adjust accordingly. The strength they use, the prefect direction that they must take to extract the graft etc.

 

They learn your head as they work on it. I am not sure a robot can have the instinct and the intelligence to understand your physiology and work accordingly.

[scar5]

Scar5,

 

There was no bluff. FUT doesn't thin out the donor the way FUE does. Period.

 

With regards to actual graft dissection, it is easy to see hairs that are in telogen if they have not shed. .... With FUE these hairs are potentially transected

 

 

 

Joe,

 

Thanks. (You have a lot of fans here-- just like me )

 

re: Bluff.

 

Strip does thin out the donor the same.

 

Why?

 

Take 2000 units out of the back of your scalp, either FUE or strip, anyway you like.

Now you have 2000 less grafts to cover the identical surface area of scalp.

 

Now you can stretch up the neck - I'll give you that. That is not the spin that strip clinic sell however. They tell us it doesn't thin, magically like FUE. Your comments about FUE holes is completely irrelevant. I hope your (our lol) fans know that by now.

 

But!!

Economics dictates the equation, as always, and FUE just doesn't have the time and skill to create the extractions in a way to hide them as well. Nothing beats nature an here strip wins because the natural order of things looks pretty much the same, albeit thinner. FUE scars can also 'pop' out in terms of lightness. So yers, apart form buckling and misdirected planes of hair, strip donor scalp looks nicer and more natural. Further more, the FUE boundaries are blunt which forms a contrast. Also can look nasty. The tone of a buzzed strip donor area looks nicer than a FUE one, apart from the zone of incision and the buckling around it. (there are no guarantees)

 

Re: graft dissection

 

 

Of course you can see the hair if is still sitting in the bundle. No one ever said you couldn't. My speculation (and it is just speculation) Is that stretching exercises are bad in the sense that they might ease out these telegon hairs.

And in FUE transection is always a possibility, with or without telegon. But the telegon story works out in favour of FUE.

 

Even so I completely agree that aesthetics is all that counts.

 

And to the guy who says that planning for a contingency akin to a "massive failure" how does this story sound?

 

Slow and steady continuing loss over a period of ten to twenty years. Lower response to drugs. More and more dependence on hair styles that are purely to 'cover up' rather than what they should be for. Slow loss of confidence as you accept inevitably that you cannot shave and that you must keep the back longer even as the crown opens up. Is that massive failure? Sounds like a common story to me.

 

Joe,

Re; the ARTAS (and I know this is a billion dollar question, seriously) how adept is it at knowing and adjusting the diameter of extraction tools? Does it do it at all?

Edited November 18, 2014 by scar5
But...

[Spanker]

I just don't see tons of "massive failures" or slow massive failures from top docs, no matter what method is used. How many guys do you see that say screw it, I now want to shave my head. Sure, scar5 is an example and behappy probably fits the category and I'm sure that there are more, but there are a lot more as far as I can tell that wasn't hair and have nice results, even as the years go by. A lot of people need another procedure but it seems like for the vast majority of people who go to top docs end of with a much more pleasing result than a shaved head. I could be wrong, but if I'm not, what are we even doing here?

[hadenough2014]

Unfortunately not my friend I am not talking about massive HT failure or a nuclear disaster on your head. I am talking about things that are common, lack of growth, unnatural looking result, drugs stop working, the patient is not happy with the density and he is all the time self conscious about it and unhappy, his supply cannot meat the demand cause his hair loss progressed passed a certain point, he had a hair transplant to early relying on drugs to keep his hair but drugs failed him or started having serious side effects.You name it there are various reasons you could regret a hair transplant sooner or later.

 

I am not talking about stretched scar or nerve damage or necrosis I am talking about an exit strategy if you are not happy with how your hair looks even though you had hair transplants. An exit strategy when you can't reach what for you looks acceptable due to various variables.

 

I know FUE is not like a virgin scalp if you buzz down but nothing can beat the smile scar! I mean it would be cool if it was a shark bite you could have a story to tell, but its just a mark of failed vanity that we could do without.

 

Well, I came to believe that 95 out of 100 patients going to top docs will be satisfied or better in the first go-round, and those 5 out of 100 who are unsatisfied will keep working at it with their doc until they get what they want. As for those who may think that top docs only show their best results, I think quite the opposite. Most who go to top docs are professionals who can afford to pay the top dollar for top results and the right to remain private...the type of people who generally will not approve use of their photos for public viewing. Many actors and other top professionals fall into this category. I sure wish I could see all of those results not shown by top docs, because I bet there are some grand slams.

 

I think you are presenting a somewhat cynical view of HT as an option for people, whether FUT or FUE. A Norwood 5 like myself does not worry too much about further native hair loss. I was almost maxed-out on loss before my procedure and I would not expect I would lose my new 4000 grafts that are DHT resistant, so I should be pretty stable, even without meds. For many, trying something is better than trying nothing. Shaving one's head as a last resort is not a confidence booster either.

[hadenough2014]

I just don't see tons of "massive failures" or slow massive failures from top docs, no matter what method is used. How many guys do you see that say screw it, I now want to shave my head. Sure, scar5 is an example and behappy probably fits the category and I'm sure that there are more, but there are a lot more as far as I can tell that wasn't hair and have nice results, even as the years go by. A lot of people need another procedure but it seems like for the vast majority of people who go to top docs end of with a much more pleasing result than a shaved head. I could be wrong, but if I'm not, what are we even doing here?

 

Agree. This industry wouldn't survive if the top docs weren't producing consistent good-to-great results. It starts with giving their prospective patients honest advice and consultation leading up to a procedure, and I think the best docs do just that.