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FUT, then FUE. Transplant no.3 - FUT or FUE?

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I got an FUT 3.5 years ago (2,100 grafts) and then got an FUE 9 months ago (850 grafts). They were with different doctors. Both approved here. Unfortunately the FUE I had 9 months ago does not seem to have worked out. I will post further info on this in the coming days but I'm going to keep it separate from this as it's too much for one post.

 

I am wondering if I've already had one FUT am I as well to get another one? Since I already have the strip scar worrying about that does not need to be part of my consideration any more. It is also quite a visible strip scar too (visible with a blade 4 and I think also 5). Perhaps the scar can be minimised with another FUT.

 

If I were to get FUE it would be beard hair. The reason for this is that I can not shave my hair. Last time I got FUE I got the 'no-shave' technique where an area at the back was shaved and the hair above that was supposed to cover it. I was told that this would be fine when I returned to work in 2 weeks but it was not. The area shaved was around 6cm and it took about 2 months for it to look normal again. I tried to use concealers but not sure how succesful they were. Not easy applying to the back of my head! Perhaps I could have a couple of cm used but not 6cm like last time.

 

I am wondering how many grafts I can get from beard transplants. I think I need about 1,000 grafts. However, beard hairs are about twice as thick so may not need as many. This may be negated by the fact that I don't think there are as many hairs per graft though.

 

The problem with getting FUT is that this is quite a low number for this. Perhaps I may need up to 1,500 grafts though. I'm not sure at the moment.

 

I am currently in Thailand. I am considering Dr. Path and Dr. Pong if I decide FUT.

 

Finally, I read on Dr. Pong's website that not all patients are suitable for FUE.

 

Although good in theory, FUE does have some major drawbacks. One of the greatest is that not every patient's scalp is amenable to FUE. In these patients, the follicular unit tends to tear while it is being teased out of the skin and damaged follicular units will not grow as well, if at all. For this reason, frequent test procedures are recommended, to check whether the patient's follicular units remain intact during the extraction process. Another major problem is that it is difficult to perform large sessions.

 

Perhaps this is a reason for my unsuccesful surgery last time as my growth rate appears to have been very, very low. My doctor never mentioned that some patients are not suitable when I recently contacted him about my grafts not growing.

 

 

 

Any opinions greatly appreciated.

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logo,

 

You certainly bring up some valid questions and concerns that many guys are faced with as to whether to go with FUHT or FUE.

 

And while I agree with some of the comments in the quote provided, FUE has come a long way with more doctors engaging with it and increasing both their talent and proficiency. Not sure when those comments were made regarding large sessions being difficult to perform, because that certainly is no longer true with those FUE surgeons who have increased their skill level including the size of each session.

 

Albeit it true that some individuals have a more "mushy" scalp texture, the instrumentation has come a long way and more patients are viable FUE candidates than say, 10 years ago. The negative forces of compression, traction, etc., in the extraction process are becoming more manageable than they were a decade ago.

 

But here's the deal. Whether we are discussing the merits of either method, the bottom line end result is largely dependent on the skill of each individual surgeon within his/her realm of competence. In other words, could the lack of growth from your prior FUE procedure be more related to a higher rate of transection than your physiology?

 

So it's always possible that your last FUE procedure may have had a completely different end result with a surgeon who has a demonstrated high skill for manual FUE compared to someone with much less experience and proven skill. The same can be said for FUHT. There are in fact several FUE surgeons who have never performed FUHT and claim that they never will. So you certainly would never consider them for FUHT.

 

Also be careful about using beard grafts as a stand alone donor source because there definitely are visual compatibility issues, growth cycle indifferences, and small graft sizes since an extremely high percent of BH FUs are single hair bearing grafts. So it would take many more BH grafts to provide the same level of visual coverage compared to multiple hair bearing grafts that only come from scalp donor. Beard hair works the best when it is mixed with scalp donor at a lower mix ratio. And I would also be careful using beard grafts on the hairline because of the visual incompatibility issues that I just mentioned. Beard hair is better suited for scar repair and in lower visual impact zones like the mid-scalp and crown IMHO.

 

Lastly, we as lay folks could never give one another objective advice as to whether or not you are a better candidate for FUE or FUHT. That requires an in person examination and the competence of a licensed physician.

 

Wish you the best in your situation along with the decisions in your journey...;)


Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians:  Dr. Robert True & Dr. Robert Dorin, New York, NY

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Thanks Gillenator. That's a really helpful reply.

 

I'm veering towards FUT. I feel since I already have the scar then it does not matter so much. From my experiences of each, I feel FUT would be easier to cover up in the weeks afterwards as I will not need to get a significant area shaved. I am not sure about beard hair. It seems to be mainly 1 hair per graft and would probably not be great along the hairline.

 

I am wondering how the next strip would be done. Would it be cut along the lines of the previous strip? Is it above or below? Is it common for the scar to be improved with a 2nd FUT transplant? I am wondering do people that have had 1 FUT generally go for FUT afterwards as the damage is already done concerning strip scars?

 

The area of my FUE surgery was above my strip scar last time. I think it was maybe a cm above. I will need to check photos again. I am hoping the doctor would not need to go in to the previous FUE zone as the hair density would be reduced here.

 

FUT was a lot more painful than FUE and had more swelling. FUE was very hassle free. However, I'm now thinking FUT may be a better option in this case.

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Tough call.

FUE (different doc) would be safer given (perhaps) your wide strip scarring tendency

Strip might get you more hair as well as thin the scar, but...

I'd say a lot of research and independent judgment is needed here.

It is a hard call. I went for strip in your situation and regretted it, but that was just my experience.

 

Just on a few general points.

 

 

So ;

 

1) You went to a clinic recommended by this website (ultra-refined) and ending up getting smallish to medium FUT and a strip scar bad enough it needs your hair grown to grade 4 - 5 to cover it? (Was that situation also the case before of after your FUE?)

 

2) Then you went to another clinic recommended and got a tiny FUE (850) which after 9 months you conclude has not worked.

 

3) Doctors/reps are giving you mixed messages about suitability for strip and FUE.

 

Let me say this.

Everybody is a candidate for both FUE - no exceptions. The degree to which it reflects a relatively better option than a strip (FUT) is based on the current situation at the clinic you ask. Basically, if they offer strip, 9 times out or 10, you will be a candidate for strip. And yes, having already got a wide strip scar, you may well be regardless of their agenda. If they offer just FUE, you will be a good candidate for FUE.

 

It seems that you didn't choose the best docs. Can't blame you for that whatsover - happens to all of us.

 

Taking FUE from immediately above your strip scar doesn't help you disguise the scar in many cases because you need that hair to shingle down over the scar. I wonder why they took hair from there? Perhaps you had thinned out below the scar?

 

Anyway, don't base you decisions about the FUE based on this tiny operation. I would avoid the doc and be wary of recommended docs and reps in general. It could be quite possible that your strip scar could improve with another strip, however it is not only width of the scar that might be an issue. If the scar is flat you are quite lucky - sometimes scars can buckle and leave you with valleys and indentations that cause shadows which highlight the scar even more after revisions. Sometimes they are better. Now you know all about the BS people talk about when they say expert docs give premium scar results, because you have gone (supposedly) to the best and got a bad scar. It is unpredictable and every strip scar is a dice roll.

 

Keep looking. Were the FUE extractions manual? Did they use a sharp or dull punch? Did techs extract the grafts?

 

You have time too. Only 9 months post FUE. i'm not sure about the shaveless system but I would expect harvested areas to be significantly thinner permanently to some a degree and quite significantly for 12 months (shock loss too).

 

But thinness in donor isn't so bad if you are thinning on top.

Edited by scar5
spllg and missed words

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It is true that some patients are difficult to extract grafts, while others have grafts that come out easily. However, you don't know necessarily if you're either one of those yet, so cannot blame that. I think if you have good laxity, FUT can still be a good option to extract more grafts.

 

I suspect based on your older photos, and assuming continued finasteride usage, you have many grafts still available, so may not need to turn to beard hair. I think the best plan would definitely be to consult with more than one surgeon, ideally in person, but based in Thailand, surely difficult.

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Tough call.

FUE (different doc) would be safer given (perhaps) your wide strip scarring tendency

Strip might get you more hair as well as thin the scar, but...

I'd say a lot of research and independent judgment is needed here.

It is a hard call. I went for strip in your situation and regretted it, but that was just my experience.

 

Just on a few general points.

 

 

So ;

 

1) You went to a clinic recommended by this website (ultra-refined) and ending up getting smallish to medium FUT and a strip scar bad enough it needs your hair grown to grade 4 - 5 to cover it? (Was that situation also the case before of after your FUE?)

 

2) Then you went to another clinic recommended and got a tiny FUE (850) which after 9 months you conclude has not worked.

 

3) Doctors/reps are giving you mixed messages about suitability for strip and FUE.

 

Let me say this.

Everybody is a candidate for both FUE - no exceptions. The degree to which it reflects a relatively better option than a strip (FUT) is based on the current situation at the clinic you ask. Basically, if they offer strip, 9 times out or 10, you will be a candidate for strip. And yes, having already got a wide strip scar, you may well be regardless of their agenda. If they offer just FUE, you will be a good candidate for FUE.

 

It seems that you didn't choose the best docs. Can't blame you for that whatsover - happens to all of us.

 

Taking FUE from immediately above your strip scar doesn't help you disguise the scar in many cases because you need that hair to shingle down over the scar. I wonder why they took hair from there? Perhaps you had thinned out below the scar?

 

Anyway, don't base you decisions about the FUE based on this tiny operation. I would avoid the doc and be wary of recommended docs and reps in general. It could be quite possible that your strip scar could improve with another strip, however it is not only width of the scar that might be an issue. If the scar is flat you are quite lucky - sometimes scars can buckle and leave you with valleys and indentations that cause shadows which highlight the scar even more after revisions. Sometimes they are better. Now you know all about the BS people talk about when they say expert docs give premium scar results, because you have gone (supposedly) to the best and got a bad scar. It is unpredictable and every strip scar is a dice roll.

 

Keep looking. Were the FUE extractions manual? Did they use a sharp or dull punch? Did techs extract the grafts?

 

You have time too. Only 9 months post FUE. i'm not sure about the shaveless system but I would expect harvested areas to be significantly thinner permanently to some a degree and quite significantly for 12 months (shock loss too).

 

But thinness in donor isn't so bad if you are thinning on top.

 

 

Yes, I could see the scar on a 4 or 5 grade before my FUE. I don't think I could see it using two mirrors but could see it when I took a photo outside and under bright light. I don't think anybody else seen it though as it was never mentioned to me. I'm pretty sure friends and family would have asked if they had seen it. The FUE above has probably not helped though.

 

Yes, I think he did FUE above the scar because the hair below was less quality.

 

An 'imported Harris punch' was used. I believe he extracted the grafts but techs put them in. Is this common? I think the extractions were motorised but I'm really not sure about that.

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