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Does the order of which you have FUT and FUE affect the potential total graft yield?


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I have already had one FUT surgery, roughly 2500 grafts. I would imagine something like FUT, FUT, FUE would yield more hair than FUT, FUE, FUE since you are excising the strip of hair and not diluting the overall density - which then allows for FUE once scalp laxity becomes problematic with FUT. Or is my thinking flawed and FUT or FUE order does not affect the potential grand total graft yield?

2516 grafts FUT - Dr. Rahal Sept 2013

1523 grafts FUT - Dr. Rahal Feb 2016

 

4039 total grafts

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404,

 

I agree: taking multiple strips and then undergoing the FUE route will likely yield the most grafts. This is actually a pretty popular method - undergoing multiple strips until you're "maxed out" and then going back for one last pass with FUE. I think the other way around - FUE then strip - would actually decrease your strip yield. FUE actually creates quite a bit of fibrotic scarring underneath the scalp, and this would likely create a pretty poor strip.

"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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I do not understand, why do you feel FUT doesn't deplete density?
In the sense that with FUT the hair is excised in a strip and closed, leaving the surrounding hair at the same overall density as before (provided that the scar does not stretch), whereas with FUE grafts are extracted all over, diluting the overall density of the hair in the donor area.

2516 grafts FUT - Dr. Rahal Sept 2013

1523 grafts FUT - Dr. Rahal Feb 2016

 

4039 total grafts

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404,

 

I agree: taking multiple strips and then undergoing the FUE route will likely yield the most grafts. This is actually a pretty popular method - undergoing multiple strips until you're "maxed out" and then going back for one last pass with FUE. I think the other way around - FUE then strip - would actually decrease your strip yield. FUE actually creates quite a bit of fibrotic scarring underneath the scalp, and this would likely create a pretty poor strip.

So it would be advantageous for a patient like me (average/less than average donor density but good scalp laxity) to go with another FUT procedure before I do FUE? A FUE surgery was next on my list as I did not want to get cut open again, but I am reconsidering if it means I would be able to harvest more grafts in the long run by doing another FUT.

2516 grafts FUT - Dr. Rahal Sept 2013

1523 grafts FUT - Dr. Rahal Feb 2016

 

4039 total grafts

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In the sense that with FUT the hair is excised in a strip and closed, leaving the surrounding hair at the same overall density as before (provided that the scar does not stretch), whereas with FUE grafts are extracted all over, diluting the overall density of the hair in the donor area.

 

 

Say you have 20k grafts in your donor, and you extract 4k, you have 16k grafts over the same area, which does not (should not) change. How can there not be a loss of density?

 

Now certainly, visually the density is not depleted that much, as we know the spacing between follicles increases by less than the diameter of the graft, but I cannot see how actual density would not decrease.

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Say you have 20k grafts in your donor, and you extract 4k, you have 16k grafts over the same area, which does not (should not) change. How can there not be a loss of density?

 

Now certainly, visually the density is not depleted that much, as we know the spacing between follicles increases by less than the diameter of the graft, but I cannot see how actual density would not decrease.

Maybe the better term to use is perceived density. If you extract 4k with strip you are still short 4k, but the overall donor area is now smaller, so perceived density does not change (provided that the scar stays thin of course)

2516 grafts FUT - Dr. Rahal Sept 2013

1523 grafts FUT - Dr. Rahal Feb 2016

 

4039 total grafts

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KO,

 

Strip will deplete density. Like you said, you take a standard area of scalp, remove a strip, and sew it up, and even if the ratio of grafts-to-scalp is the same, you still have less usable grafts.

 

My point was that strip tends to create less diffuse subcutaneous fibrosis (ie scarring). This means that once you've "stripped out," you can still go in and cleanly remove FUE grafts. However, if you have diffuse scarring from FUE, the strip you remove later will contain this fibrotic scarring and likely yield less usable grafts.

"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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404,

 

Are you happy with your current strip scar?

 

Doing another strip and then finishing with FUE will likely yield the most grafts. You could, however, scar worse from the second strip closure - especially if you have increased tension on the scalp. If the scar is acceptable, you could always do FUE procedures from here on out. It's a bit difficult to say which would be "best" based on this interaction alone, but the above is probably something to think about.

"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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