FUE vs. FUT (strip surgery)? Ask yourself this question!!!

[JohnCasper]

If the process known as FUE had been originally created and used initially as a means of extracting grafts from a vast donor area, would the FUT (strip surgery) ever had been created, and would it ever be a method of choice by the patient?

 

 

 

I contend that FUT strip surgery would not be the method of choice by the patient. I believe that FUE is without question the best process for the patient. FUT strip surgery, however, can arguably be the best process for the surgeon. The surgeon, in a relatively short amount of time, can make lengthy incisions across the back of your head, hand the “strip” off to a trained technician to dissect the grafts and prepare them to be transplanted. The patient is left with an eight inch scar (average of 22 cm), and a limited number of grafts from the strip. With FUE, the surgeon has a vast area of donor hair and the surgeon can pick and choose areas based on donor density and choose hairs based on caliper size to be used in strategic cosmetic areas such as the front hair line. The FUE patient is left with a donor area that heals very quickly without ANY visible scarring.

 

 

 

Again, I have to propose a similar question…. as the patient, would you prefer to have an eight inch scar forever on the back of your head and have most of the hair you want? Or… would you prefer to have NO visible scarring, offer a vast donor area for the surgeon to extract specific grafts for strategic relocation, and allow the surgeon to choose the exact number of grafts needed to produce the desired results?

 

 

I have had two FUE surgeries. The first procedure over several days in September of 2012 included 5,125 grafts and most recently a 2,000 graft procedure performed last month. I have NO visible scarring from the original surgery. I’ve included a before and after picture on my profile but will be posting more from my past surgery as well as my most recent procedure. I’ve been writing and chronicling my 2012 surgery on my own blog for over two years which has been visited more than 44,000 times. I have communicated with people who have contacted me from all over the United States as well as hair surgeons from around the world who have visited my blog. I’m looking forward to posting on the Hair Restoration Network and hope to help others through my personal experiences regarding this very important decision in their lives.

[fisher4man]

More FUE grafts transplant more hairs to the transplanted area, -even one more graft.

 

More FUT grafts do not add more hairs to the transplanted area. You can obtain 3000 or 5000 grafts from 60 cm2 FUT strip, but the transplanted hair number is still the same.

 

NOTE: (just to increase the number of grafts in FUT ( I do not know the reason for that:)) Trying to cut 4-hair FU graft into two 2-hair FU graft may also produce one singleFU graft, plus one 2-hairFU graft and one hair may go to the garbage:))

 

So, I agree, FUT with 5-6K grafts is a good choice for surgeons.

[PupDaddy]

Most of the very best cosmetic results I've seen, and continue to see, have resulted from strip procedures. This could partly be due to more docs having gotten their initial training with strip, meaning more excellent, artistic surgeons and their staffs have had more time and experience with strip, leading to consistently excellent cosmetic results. But I also think that strip harvesting, practiced by the best docs and clinics, simply yields more consistently good grafts than does FUE. That said, FUE tools, techniques, and protocols and technique are rapidly improving (I applaud the doctor you represent, Dr. Vories, for recently ditching the Neograft machine) and paying dividends, although yield continues to lag behind strip, mostly due to higher transection rates and poorer survival and poorer full growth of the skinny grafts obtained via FUE vs. the chubby grafts obtained via strip. Patients' donor areas will yield many more total grafts for multiple ht procedures through a combination of strip and FUE than they would if only one or the other extraction method were available, and the consensus of ht surgeons posting here is that the total lifetime numbers are significantly higher if strips are exhausted first.

 

So I don't know. It isn't so black-and-white as you pose the question. I suspect that if FUE had been developed and perfected first, as the primary method of harvesting grafts for hair transplantation, strip still would have been developed because of the limitation on total harvestable grafts via FUE before the donor area starts to look moth-eaten. It isn't necessarily an either/or situation, but it's an interesting question nonetheless. (Of course, some might argue that you have an incentive to steer prospective ht patients away from strip towards FUE since you represent a doc who only performs FUE -- but I didn't read your post that way.)

 

Please keep us updated on your second pass FUE with Dr. Vories. Good growing!

[scar5]

I suspect that if FUE had been developed and perfected first, as the primary method of harvesting grafts for hair transplantation, strip still would have been developed because of the limitation on total harvestable grafts via FUE before the donor area starts to look moth-eaten.

 

I hear you but respectfully disagree - I mean, pure hypothetical of course.

 

Once FUE was established and once a donor had been thinned out I don't see why anyone would slice and massive line right down the middle of it for the sake of more grafts.

 

But to the OP - brilliant. Yes, ultimately FUE suits patients and strip suits surgeons. In the short term however, there is no denying the massive 'shock' results that strip had produced and continues to produce for some people in the front-on picture in the shorter term. But they'll need to go back for more and every scar is unpredictable. And if the meds hold out, maybe they'll be OK.

 

Later as you age, you look at the thinning crown you start to wonder. When you realize it is time to buzz or 'rock the horse-shoe' you are beaten.

 

There is also a psychological and social dimension to the strip scar. It is a symbol of something quite disturbing for some people. Even if you personally can cope, can you cope if the people around you judge you adversely for it? Will they ever know? Something at the back of your mind (and the back of your head). The FUE dots, meh, not so much, not by a long shot.

 

FUE started in 1988. Strip started just a few years earlier. Previously, and even later, punch grafts and scalp-reductions dominated. FUE was immediately ostracized by the hair-medical community. Strip was a massive boon to the HT community because of its economics - just as the OP says. The road FUE had to take was incredibly slow.

 

These days, these boards have opened up and let the sun shine in. It wasn't so long ago that you would be shunned and shouted down for suggesting that there should be FUE vs strip debates. 'Not that again' was the popular refrain. Finally we are moving!

[KO]

Actually, I think if FUE had developed first, Strip would have come about later as a "niche, boutique" procedure for people who are not good FUE candidates. After all, most men have moderate hair loss which FUE can handle. Not everybody is a NW5+.

[Questionmark]

I`m an advocate for FUE in most cases, but FUT still has its place in hair transplant approaches imo, especially in female cases.. Apart from that, in some cases only a combo provides the necessary amount to get the perfect result. In these (rare) cases one has to do strip and harvest via FUE until the point the scar isn`t visible. So for example in your case, as long as the scalp is not shown due to FUE over-harvesting in the donor zone, you could still do a strip procedure in order to add more density in the recipient area.

 

Still I see the huge disadvantages of FUT that for example scar has mentioned. In the end it`s up to each patient to decide. I personally wouldn`t wanna have a scar over my whole backhead, even if it`s thin, it`s just that psychological effect.. Uuuughh But some people appearently don`t have an issue with it..

 

I congratulate on your procedure, it`s looking awesome and perfectly showcases the potential of FUE-only in high NW cases, and you are right to a far extent, but imho we don`t need another FUE vs. FUT debate. At least I don`t lol You guys have fun

[scar5]

but imho we don`t need another FUE vs. FUT debate. At least I don`t lol You guys have fun

 

Precisely the mechanism reps exploit to shut down inquiring minds

 

Who is we?

 

Rest assured that many young men will wrestle with this issue in the coming year.

 

Good thing we are past it. Been there done that.

[Questionmark]

I get your point I guess. What I intended to say however is that the issue got discussed exhaustively in numerous threads over the past years. And it really got discussed exhaustively... I also tried to sum up the most prominent arguments. Furthermore, did I take a one-sided or biased point of view (then please tell me in which way), or do you even think that I`m a rep (??? for whom, and how would my post be in favor of any doc?). I don`t wanna block any discussion (why would I), but I am somehow allergic to this topic being brought up again and again and again as if it would be something totally new.. I just don`t see any new arguments.. So that`s why I said that you guys have fun, it was just a lil sarcasm from my side, I thought I`m not the only one maybe....

 

But I am the first to welcome any patient being prevented from being unnessessarily FUT-butchered (sorry for the term). Still there are cases where FUT is not totally bogus. And in the end it`s up to the patient to inform him/herself and make an educated decision. All the information is available in meanwhile dozens of threads. This is just another one. That`s all I tried to say..

In no way did I intend to undermine any fruitful and useful discussion. If only one patient makes the better choice based on the study of this thread, we win. We can embellish another thread with all the arguments.. So in this sense my comment maybe was "wrong", but it wasn`t my intent.. I get your point, hopefully you got mine.. Greetz

Edited February 7, 2015 by Questionmark

[scar5]

I get your point I guess. ....

 

...exhaustively...numerous threads...past years....exhaustively... again and again and again.......dozens of threads.

 

.. I get your point, hopefully you got mine.. Greetz

 

I think I know precisely where you are coming from.

[Questionmark]

I think I know precisely where you are coming from.

 

Oh gosh. Excuse me? I don`t want to break the netiquette, so I better not comment on that. Just that it`s pretty amusing... I`m from Munich actually.. Have a good day, Alice

Edited February 7, 2015 by Questionmark

[mikeey]

I wish to highlight the question :

Does FUE sometimes result in half grown Hair ? I have never heard of this , I always thought that once a graft is broken from the surface skin it will just grow , get thicker and mature .

 

Never thought that FUE Grafts might stop growing halfway after they have poked out of the skin ,

 

any member who had FUE , ever experienced this ?

[JohnCasper]

I certainly appreciate everyone's opinions on the FUT vs. FUE debate. I'm sure each procedure may have its advantages over the other. I refrained from entertaining FUT originally because I just didn't want the scar. Even if the scar is covered, most people know it is there. I like being able to tell people that I have over 7,000 grafts moved and don't have a visible scar on my head. FUE was the only choice for me but clearly many people are thrilled with their FUT results and I am very happy for them! All of you who posted responses make great points and I appreciate your respectful professionalism in the discussion. I'm looking forward to dialoguing with each of you in the future and posting results of my surgeries on the HTN site!

[scar5]

Oh gosh. Excuse me? I don`t want to break the netiquette, so I better not comment on that. Just that it`s pretty amusing... I`m from Munich actually.. Have a good day, Alice

 

It's OK. I think you have nice manners and I know nice manners help.

 

When I was a kid I didn't understand advertising at all. If I saw a Coke sign or a message like 'Have a Coke' I just thought, why bother? Why tell us again and again about 'Coke'. We already know what Coke is! And why put up a big sign that says 'Have a Coke' ..such a daft expression. Nobody is gonna have a Coke when they read it, instead they are gonna hate on Coke for being so stupid as to assume so. That's what I thought.

 

Let me ask you this. How many times did you read the same old stuff from Joe and Spex - stuff like FUE causes scarring? Did you tell them you were growing tired of hearing that? I mean that politely.

 

Anyway, it is all changing rapidly through all the years we have had the same arguments.

[Questionmark]

Hi, to me you partly are still speaking in riddles, but it also seems your last post is some kind of conciliation? It`s just very hard to be accused to be as someone dishonest, it`s actually a pretty hard insult for me, because all my life I try to be the exact opposite..

Funny that you`re mentioning Coke, as I not too long ago tried to taste the drink just like it is, mentally turning off all the exciting associations my mind got programmed with, just my senses and me - and guess what, it tasted like pure garbage lol I learned a lot from that only

 

Regarding your question if I commented against bogus and money-led anti-FUE rants: I`m a reader on here (and some other boards) since early 2013, and active since early summer the same year. Spex is not active a long time it seems, and I came at the time guys like Mickey did a hell of a job in setting things straight regarding FUE, while I still had to orientate myself in the whole field. I do remember, though, to have yet taken a substantiated stand in favor of FUE (you can search in my posts if you got the time and nerves ) Anyway I always actually took a stand against unnecessary FUT, and unnecessary it is in most cases imo. I furthermore collected knowledge and experience on here in order to share it at the biggest german board, which was and still is behind in many regards. I was the one to set things straight regarding FUE vs. FUT there, and also made efforts so people can get a more sophisticated view in regards to motorized vs. manual punches. Things really have developed imo, nowadays nobody would make some ridiculous statements which have been made in the past to slam FUE... But if I`d read them now, of course I would intervene and take a stand.

 

I hope it`s alright now, I really didn`t intend to undermine any useful discussion, just wanted to emphasize that advantages and disadvantages could be known by now.. Greetings.

[Sethticles]

I am very much PRO FUE, I have had two FUE HTs, and I am extremely happy with the results, over the last year Ive seen two occasions FUT scars out in public, both obviously given up trying to maintain a full head of hair and now just shaving it, and their scars were massive. i felt like going up to them both and suggest a FUE repair job to the scar but really non of business, im sure they live with knowing full well that the scar exists - i do worry for future FUT patients when FUE works

[scar5]

I hope it`s alright now, I really didn`t intend to undermine any useful discussion, just wanted to emphasize that advantages and disadvantages could be known by now.. Greetings.

 

Yeah, its fine. I realise you are sincere, I just had to watch the strip clinics shut down or confine FUE for so long, I got tired of hearing, 'I'm tired of hearing this'

 

Progress has been made.

[KO]

Yeah, its fine. I realise you are sincere, I just had to watch the strip clinics shut down or confine FUE for so long, I got tired of hearing, 'I'm tired of hearing this'

 

Progress has been made.

scar5, I am surprised that you have not commented on the "Donor site left open" thread.

 

http://www.hairrestorationnetwork.com/eve/177864-what-happens-when-donor-site-left-open.html

[Questionmark]

Progress has been made.

 

Indeed. Things develop for good

[scar5]

scar5, I am surprised that you have not commented on the "Donor site left open" thread.

 

http://www.hairrestorationnetwork.com/eve/177864-what-happens-when-donor-site-left-open.html

 

Don't tempt me!

 

I'll say is something like, 'duh..surprise" and the strip guys will say, 'It's very rare'..

 

but as I have alluded to in this thread, the airspace gets filled up with info of one persuasion or the other. I'm glad strip is getting a hammering lately - much deserved IMO.

 

Cudos for that guy posting

[JohnCasper]

Regarding the recent conversations including scarring with FUE, I'd like to post a picture that was taken on January 10th of this year of my donor area prior to my second surgery. Two years ago I had 5,125 grafts transplanted and I'm sure a large number of these came from the area in the picture. I can see no visible scarring in my left donor area. I certainly welcome your thoughts and responses.

[KO]

Hey John, what are your/Dr V's opinions on the advantages/disads of the Hans Lion Implanter? Has there been a visible impact on yield vs using blades?

 

 

It seems to be a regional thing as Dr Vories wrote, not too many Western surgeons use its relative the Choi pen, and early on it was derided by people like Feller and Rassman that it's maybe good for inexperienced practitioners.

[wazaam]

Great question about the Choi pen. I hope we could get Dr Vories to respond & provide his input regarding this.

 

Look forward to following Dr Vories future FUE work now that he has stopped using Neograft.

[Michael Vories, MD]

To add to this discussion, it is all about the tissue. Whatever we can do to extract this delicate tissue without exposing them to drying out, then it should be done. That is why we stopped using the NeoGraft machine. Whatever we can do to place intact, wet tissue into the scalp without trauma, we should do that. That is why we use Implanter Pens. The variability of growth seen with FUE is not necessarily due to extraction. Placing tissue without trauma to this fragile tissue can be very difficult, even for experienced placers. Our staff has been hand placing grafts for over 10 years, yet we see much more reliable results using the Implanter Pens.

[Swooping]

Hey John, what are your/Dr V's opinions on the advantages/disads of the Hans Lion Implanter? Has there been a visible impact on yield vs using blades?

 

 

It seems to be a regional thing as Dr Vories wrote, not too many Western surgeons use its relative the Choi pen, and early on it was derided by people like Feller and Rassman that it's maybe good for inexperienced practitioners.

 

What is the difference between a Hans Lion implanter and the Choi pen? Thanks in advance.

[Michael Vories, MD]

I was introduced to the Hans Implanter Pens during a visit to Dr. Jose Lorenzo's clinic in Alcobendes. They are much sharper than the Choi pen, with less 'popping" of grafts, and allows for more dense placing of grafts.