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Animosity towards FUT over FUE, help me understand.


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Hello Everyone!

 

I have been growing in worry about my thinning hair, I think maybe I am about a NW3, but perhaps you can tell me different as I will be posting what I have to deal with today.

 

Anyway, this thread isn't about that. It's about the animosity towards FUT procedures, I don't understand it and maybe you can help me understand.

 

I am going to be getting a consultation with Dr. Arocha in Houston Texas in a few weeks because I hear he is very reputable on here and in general. As well I see his great results that are NOT on his site (in no offense to his clinic, anyone would want to show all the success stories on their site, and they are great). However, Dr. Arocha uses both FUT and FUE, from some comments on this forum and others online I've heard phrases such as but not limited to including towards FUT procedures:

 

"Stone age technology"

"Shouldn't be used anymore"

"Why mutilate your head?"

"Should be illegal"

 

I just don't understand these sentiments. I look at users such as scooter, who've had fantastic success with FUT. I've seen countless people on here who've had both done with no problems.

 

I intend to keep my hair long, forever. I guess I don't see the problem with FUT, is it more invasive? Sure. But in the end if no one can see the scar, I really don't care. And if FUT is the more recommended option (cost is not an issue for me), why would I not want FUT?

 

Also, if its such a barbaric method compared to FUE, then why do well renowned doctors such as Dr. Arocha use it? I think you see where I am going with this, I feel like its just a bunch of hot air people are shooting up, but I wanted other peoples thoughts.

 

Help me understand this crazy sentiment.

 

 

Side Note:

Here are some pictures of my head. If/when I go with Dr. Arocha I will give an update because I believe good work deserves to be known by a 3rd party as well. Maybe you guys can guesstimate how many follicles I'll need. :P

 

Also, maybe if someone could provide a good review of Arocha this will help seal it for me as well, I have seen plenty, but you can never get enough reassurance. :)

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  • Senior Member

Because the few that had a bad experience let it be known on here. I don't blame them but not all are in the same boat. You never hear someone post "Look how invisible my scar is". Complaints on forums always out way the success. I had one just over two months a go and I already can hide it with short hair. It depends on what your donor quality is, and what you want.

Dr.Gabel 3972 FUT 11/3/14

Progress/Results Below ;)

http://www.hairrestorationnetwork.com/eve/177388-3972-fut-dr-gabel.html

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It's all about the linear scar, Bardlebee. Some ht candidates are inalterably opposed to being left with the FUT linear scar. There are legitimate cosmetic reasons for this aversion: Some people plan to wear their hair very short on the sides and back as a matter of style, e.g., shaved down to a #1 or #2 blade. Other people are concerned about the distant future when their hair thins. The "safe zone" isn't immune from the effects of DHT, it's just more resistant to it and for a longer time. Most men's donor hair thins somewhat as they reach more advanced age, which also means that the hair transplanted from the donor will eventually thin somewhat as well. Plus, whatever native hair that had left on top likely will miniaturize or disappear over the very long haul. So they want the option to shave their hair down close in their later years without worrying that the linear scar will show. Another scar-related FUT concern is if the transplant "fails" or the result isn't what the patient had hoped, and now they have a linear scar to deal with, which can limit their options to shave things down.

 

However, if the FUT linear scar were to become an issue in any of these situations, many men could have the linear scar fairly well camouflaged via FUE, pilofucus (Dr. Wesley's emerging scarless extraction technique) and/or SMP.

 

Really, the scar's the thing. An increasingly large percentage of ht candidates are willing to accept the generally lower yield of FUE and the lower numbers of available transplantable follicular units compared to FUT (per session and in total) for the sake of avoiding the FUT linear scar.

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It's all about the linear scar, Bardlebee. Some ht candidates are inalterably opposed to being left with the FUT linear scar. There are legitimate cosmetic reasons for this aversion: Some people plan to wear their hair very short on the sides and back as a matter of style, e.g., shaved down to a #1 or #2 blade. Other people are concerned about the distant future when their hair thins. The "safe zone" isn't immune from the effects of DHT, it's just more resistant to it and for a longer time. Most men's donor hair thins somewhat as they reach more advanced age, which also means that the hair transplanted from the donor will eventually thin somewhat as well. Plus, whatever native hair that had left on top likely will miniaturize or disappear over the very long haul. So they want the option to shave their hair down close in their later years without worrying that the linear scar will show. Another scar-related FUT concern is if the transplant "fails" or the result isn't what the patient had hoped, and now they have a linear scar to deal with, which can limit their options to shave things down.

 

However, if the FUT linear scar were to become an issue in any of these situations, many men could have the linear scar fairly well camouflaged via FUE, pilofucus (Dr. Wesley's emerging scarless extraction technique) and/or SMP.

 

Really, the scar's the thing. An increasingly large percentage of ht candidates are willing to accept the generally lower yield of FUE and the lower numbers of available transplantable follicular units compared to FUT (per session and in total) for the sake of avoiding the FUT linear scar.

 

Okay, I think this really puts it together for me. You mention yield, I am under the impression that FUT yield, as in the hair that goes into your scalp implanted, has a better success rate of "sticking" then FUE, is this the case? So where as if I transplant say 2000 follicles with FUT vs FUE, FUE would have fewer follicles come out as permanently grafted and may not transplant as well as FUT?

 

I think this is the only gap (I hope) in my marathon like research I have been doing the past month.

 

I am really excited to do this, to be honest. I really feel like with the combination of this implant and a regimen of Minox+fin is going to help me for many years. :)

 

I am not yet on finasteride, like Propecia, so the one thing I do worry about is shock loss and if I should be on that for awhile to counteract the possibility of shock loss.. but that is another topic ;)

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IMO, if you think that you have matured enough to answer this question -"Am I willing to have a bald crown with hair in all the other places?" then you can make a rationale decision.

 

I certainly was never (and still struggle) to make that decision.

 

You lose more hair as you age, with or without meds (but especially and devastatingly so without them)

 

With a strip scar you need to grow the horse shoe so if you lose the crown you're out of luck. But many guys I know in their 40s and 50s look quite dignified with their bald crowns. I suspect it is bluff, and that they hate it, but they look like they are cool on the outside.

 

The strip scar messes with your head psychologically too. You lose perspective sometimes.

 

So it is about maturity and a dose of luck.

 

All the sales talk is mostly spin based on economics and laws - these dictate the way the industry has gone in The States and created an off shore market.

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Bradlee,

 

Pup hit the nail on the head: the controversy lies with the linear scar.

 

This is why I personally believe there are patients who are better suited for strip procedures and those better suited for FUE. These strip patients MUST understand the reality of the linear scar. But if they do, I think they will simply receive more "bang for their buck" with strip (FUT). Frankly, you seem like one of these patients.

 

Discuss FUE versus strip thoroughly with Dr. Arocha. He's very comfortable with both methods. Share your goals and what you see as the "pros and cons" of each procedure. Lastly, come up with a solid - and personal - answer to this question: would I rather shoot for increased yield in one pass and deal with a variable linear scar? Or, would is the scar a "deal breaker" and I'd prefer more variable yields with less visible scarring?

 

The true solution to this issue will be a method with strip yields and FUE-level scarring. Until that point, however, I think the above advice holds true.

"Doc" Blake Bloxham - formerly "Future_HT_Doc"

 

Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

 

All opinions are my own and my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician.

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You mention yield, I am under the impression that FUT yield, as in the hair that goes into your scalp implanted, has a better success rate of "sticking" then FUE, is this the case? So where as if I transplant say 2000 follicles with FUT vs FUE, FUE would have fewer follicles come out as permanently grafted and may not transplant as well as FUT?

 

Yield refers to two things: a) the percentage of transplanted follicular units that grow, and b) the percentage of transplanted follicular units that grow the same number of hairs that comprised them before they were extracted. If you've done a good bit of research, you will recall that modern day hair transplantation involves extracting and transplanting naturally occurring follicular units, each comprised of either 1 hair, 2 hairs, 3 hairs, or, occasionally, 4 hairs (the 1-hair follicular units are placed in the very front of the hairline).

 

These days, when practiced by skilled and experienced physicians with excellent technicians, FUT yield usually is very high in both respects -- a very high percentage of the transplanted follicular units grow, and a very high percentage of them produce the same number of hairs they originally had. This is because the follicular units are dissected from the extracted strip under high magnification microscopes, using very thin, very sharp blades (razor blades, essentially). Because the technicians can see what they are doing, and can see where to cut between the follicular units, there is minimal "transection" of follicular units during the dissection process (transection means cutting into or across the bulb of a follicular unit). In dissecting out the follicular units from the strip, the technicians are also able to maintain a healthy amount of fat and tissue that surrounds each follicular unit and protects it during handling and implantation. FUT dissection produces what the industry terms "chubby" grafts, which is a good thing. Also, some docs have their techs purposely dissect some double or even triple follicular units from the strip for strategic placement in regions behind the hairline for added density. (This can't be done with FUE because the punch would have to be too large and leave too large a round scar.)

 

FUE poses challenges to graft extraction not faced by FUT graft dissection. The doctor or technician is punching "blind" into the scalp, hoping that the bulb of the follicular unit beneath the surface of the scalp is in line with the angle of the hairs the exit the scalp. This isn't always the case, particularly for patients with wave or curl to their hair. This can -- and usually does -- result in the bulbs of more follicular units being transected than with FUT strip dissection. The challenge is exacerbated by the small punches being used in today's FUE to try to minimize the appearance of the punctate scarring (the "white dots") in the donor area from thousands of punch excisions. The smaller the punch, the greater the chance of damaging or transecting a follicular unit, and the less protective surrounding tissue is able to be extracted with the follicular unit. It is said in the industry that FUE produces "skinny" grafts or "skeletal" grafts, which can compromise their survival. A further challenge to FUE graft survival is that some grafts require some pulling/torsion with forceps to fully free them after they have been punched.

 

Each of the challenges disused above can negatively effect yield from FUE compared to yield from FUT, in both respects mentioned: percentage of transplanted grafts that grow, and percentage of grafts that grow the same number of hairs they originally had (e.g., a 3-hair follicular unit that was partially transected during punching or that was damaged by torsion or during handling and implantation could grow, but it might produce only 2 hairs or 1 hair).

 

All that said, the best FUE docs and clinics appear to be producing better and better yields than in the past. There have been some efforts to quantify FUE yields vs. FUT yields, but I don't know of any current reliable studies or estimates. Some docs claims that their FUE yields rival, or are at least in the same ballpark, as FUT yields.

 

I hope that helps. There are many, many threads and posts on this site about this topic, so use the search function and dig around.

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Thank you PupDaddy/Blake/scar5,

 

You've really helped me put all these pieces together for the start of my journey, it is a shame that Limmer in San Antonio isn't currently around for consultation from what I hear as well for this. While I am sure his successor is more then capable, I am not willing to risk it for my first go around and hopefully last transplant if I react well to fin+minox. I do look forward to seeing Dr. Krejci's work on this forum though when that happens. :)

 

PupDaddy, thank you for that explanation, I have read time and time again FUT had generally been better for yield, but its never been explained in the detail you laid out. This has helped me a great deal.

 

Blake, thank you for your confidence in Dr. Arocha as a choice. This is a very scary time for me as I am sure you well know for anyone first transplant.

 

I have not consulted with anyone just yet, Dr. Arocha so far is the only person I have chosen to consult with. Looking at his work and listening to you guys he sounds like a great choice. Although, I don't think I would be willing to travel to consult with other doctors across state lines for this.

 

I may consult with Limmer's team as well too, but I worry I am not consulting with enough doctors. I have done tons of research on this topic, with only what I feel being small gaps in my knowledge. I feel like I wouldn't go wrong going with Dr. Arocha so maybe I shouldn't need to consult with 5 other doctors.

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I have not consulted with anyone just yet, Dr. Arocha so far is the only person I have chosen to consult with. Looking at his work and listening to you guys he sounds like a great choice. Although, I don't think I would be willing to travel to consult with other doctors across state lines for this.

 

Many docs now offer virtual consultations where you email them photos, which they assess and then email you back a proposed restoration plan, including proposed graft numbers and pricing. If the doc offers both FUT and FUE, they can give you proposals for both (FUE is usually more expensive). A number of docs also offer Skype consultations after you email in your photos, which is a great opportunity to talk to the doctors, ask questions, compare their approaches, and see who you're comfortable with, without having to travel about. Or you might find that you can narrow things down via virtual consults to two or three docs and then follow up with in-person consults with the two or three docs on your short list.

 

Good luck!

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Many docs now offer virtual consultations where you email them photos, which they assess and then email you back a proposed restoration plan, including proposed graft numbers and pricing. If the doc offers both FUT and FUE, they can give you proposals for both (FUE is usually more expensive). A number of docs also offer Skype consultations after you email in your photos, which is a great opportunity to talk to the doctors, ask questions, compare their approaches, and see who you're comfortable with, without having to travel about. Or you might find that you can narrow things down via virtual consults to two or three docs and then follow up with in-person consults with the two or three docs on your short list.

 

Good luck!

 

I am equally as excited to get started with a transplant as I am cautious. Not a good combo, I think.

 

I have a feeling if I like Dr. Arocha's team I will be going with him. Since price point isn't a big concern for me, he seems like a really good doctor to get this work done.

 

I guess the last question I had, since this topic has clearly changed to more my situation, is how much time should I spend safely researching this? If I have spent a month just marathon researching on the internet, is that enough? I know there is no well defined number, but I see some people saying do your research for at least a year or two years! I think that is a little insane, I know it is a surgery, but time is not my friend if you know what I mean. :)

 

Like in my case, I am finding it hard not to go with Arocha just based on research alone, if I don't like what I see when I consult with him that is different, but why bother continue to consult with 5-10 doctors if I've consulted with 2-3 and one seems good out of them?

 

Maybe I think I am asking questions I can only answer here... as personal preference and safety. :P

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I'll throw in one warning for you, (take it as you will)

 

Doctors based in the states prefer to do strip and the more hair you need, the more they prefer to do with strip.

 

(I won't go into details other than to say) This is because of economic, health (their health), exposure to risk, and the unfortunate fact that technicians cannot legally extract follicles from your head.

 

When it comes to 'bang for buck' strip wins - but it is the doc, rather than you - that is the real winner.

 

It takes anywhere from 10 to 40 minutes to cut and suture the strip that yields 4000 follicles. It takes several long physically and mentally taxing days to achieve the same with FUE, all for a weaker yield.

 

But that is where it ends.

10 days out of FUE you are on your way. You can live your lifestyle like you could pre-op. And here is the thing, everyday you live herein, you can know that whatever happens to you in the future, you have the option of retreating from the HT with dignity by buzzing your head.

 

if you do a strip, your worries might takes several years (even decades) to surface.

 

Think carefully.

 

Docs in Canada, Australia and the US as well as docs performing strip and FUE everywhere around the world prefer to do strip.

 

you look like you have already lost a fair amount of hair. This makes you a candidate for spin along the lines of "Strip suits big jobs and FUE suits small jobs"

 

If technicians could extract legally in the United States, you might be hearing a very, very different story.

 

That is all I'll say and best of luck to you.

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Hello Bardlebee.

Apart from taking on board what others have already stated and some very goods points have been high lighted to you I think you should look beyond these.

With either there are the risk of complications but with fut I think the risks are much greater.

We still see plenty of scar revision surgery and if you look at a resent case were the donor was left open because of excessive tension complications still arise.

If you are after a one pass procedure yet hit complications with fut you will need to go through it all again just to reduce scarring.

Have a look for the thread about the donor being left open which to my mind is a massive advert for choosing fue over fut.Let's not forget that this was done by a recommended doc and as far as I know he is still unnamed so it could be any recommended doc in the states.

I am pro fue but if people choose fut good for them and I wish them all the best,

Have a good day

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The Problem with FUE is the yield , and its a blind technique as you cannot see what the punch is doing below the surface and how the follicle is placed , hence many transected grafts in other words useless and wasted , whatever you caution on FUT is True and there is No denying that complications are more than Fue , and even the pain is severe in FUTwhen compared to FUE , Becos hey after all the skin is cut and stitched , But if done with care , it gives you great results , NOT all docs leave the donor open , such accidental mistakes even happen with Fue . I was pro Fue too , But the Results after 1 year are not convincing ... and FUT is Illegal to be performed by Techs ..... I better die from a Doc .... than from his staff !

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Mikeey there are several other complications than the example I mentioned.

I may be wrong but it seems to me shock loss seems more prevalent with fut than fue.

Hair growing different directions above and below the scar ect ect both techniques have their pros and cons but why is fue becoming so popular ?

Its not just newbies doing a bit of research but old hands who have been on the boards for years researching such as myself.

I am going with fue thats my choice but I would never try and persuade anyone to do either technique over the other.

I would advise them to research thoroughly each technique and make their own personal choice based on their research.

Have a good day

 

 

The Problem with FUE is the yield , and its a blind technique as you cannot see what the punch is doing below the surface and how the follicle is placed , hence many transected grafts in other words useless and wasted , whatever you caution on FUT is True and there is No denying that complications are more than Fue , and even the pain is severe in FUTwhen compared to FUE , Becos hey after all the skin is cut and stitched , But if done with care , it gives you great results , NOT all docs leave the donor open , such accidental mistakes even happen with Fue . I was pro Fue too , But the Results after 1 year are not convincing ... and FUT is Illegal to be performed by Techs ..... I better die from a Doc .... than from his staff !
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