FUT is less costly compared to FUE. Can i choose FUT?

[Blake Bloxham]

Weare,

 

Poaching my peeps?? I can't compete with those cut rates ; )

 

Vox,

 

Drinks are on me next time in back in CA!!

[voxman]

 

Vox,

 

Drinks are on me next time in back in CA!!

 

I will hold you to that!

[KO]

Are you in NYC? I just moved here, might drop down for a consult with Bloxham&Feller..

[Blake Bloxham]

Yup! Great Neck, Long Island. I'll be out there full time staring July. Stop by anytime!

[BUSA]

Yup! Great Neck, Long Island. I'll be out there full time staring July. Stop by anytime!

im only an hour away. I might do the same Blake.

[BUSA]

Err,how could that question be any simpler or more direct??

You have 5500 posts in your profile which I have no desire to trawl through .

Are you a qualified physician ?

the search button is ur friend. unless ur too lazy or stupid to figure that out on ur own....:rolleyes:

 

and just to appease ur ignorance there are several clinics around the world performing quality HT's that have techs performing them so being an actual doctor vs. one in training with one of the top HT doctors in the world really doesn't mean shiit wen it comes to HT knowledge that Blake has.

 

uve been awarded TROLL of the month! Congratulations! a free TROLL poster is on its way. you can hang it with pride over ur computer....:rolleyes:

 

but since ur likely one of the recent BANNED nut huggers ur probably well aware of everything I posted.

Edited May 17, 2015 by David - Moderator

[frankwhite]

the search button is ur friend. unless ur too lazy or stupid to figure that out on ur own....:rolleyes:

 

and just to appease ur ignorance there are several clinics around the world performing quality HT's that have techs performing them so being an actual doctor vs. one in training with one of the top HT doctors in the world really doesn't mean shiit wen it comes to HT knowledge that Blake has.

 

uve been awarded TROLL of the month! Congratulations! a free TROLL poster is on its way. you can hang it with pride over ur computer....:rolleyes:

 

but since ur likely one of the recent BANNED nut huggers ur probably well aware of everything I posted.

 

I and the rest of the users of this forum am well aware that you, BUSA, are a first class prick and indeed the most persistent troll on the forum.

Who is it that routinely trashes most of the doctors who post results here whilst extolling the virtues of a few virtually unknown Turkish clinics at every available opportunity?

I, on the other hand, merely asked a simple and straightforward question - no agenda,no trolling,no insults or bullshit, just a question which has now been answered and my curiosity has been satisfied.

Edited May 17, 2015 by David - Moderator

[Sparky]

From personal experience I have had high yeild but terrible results from strip, ie: bad angles, bad scar, some pitting and bad looking grafts from strip, yet they seemed to all grow, although it would of been better if they hadn't grown. My fue experience equates to not noticiable scarring, although I have white dots, but the yeild is much lower. All things being considered with hindsight I would still have fue as you can still shave it off to a certain extent, like scar5 said, you can still 'get out', but with a strip scar, you are commited.

 

I just hope I don't lose anymore hair so don't have to deal with shaving down in the future.

[hairweare]

Sparky, perhaps in both cases it was your choice of surgeons rather than the technique that led to your results.

[frankwhite]

the search button is ur friend. unless ur too lazy or stupid to figure that out on ur own....:rolleyes:

 

and just to appease ur ignorance there are several clinics around the world performing quality HT's that have techs performing them so being an actual doctor vs. one in training with one of the top HT doctors in the world really doesn't mean shiit wen it comes to HT knowledge that Blake has.

 

uve been awarded TROLL of the month! Congratulations! a free TROLL poster is on its way. you can hang it with pride over ur computer....:rolleyes:

 

but since ur likely one of the recent BANNED nut huggers ur probably well aware of everything I posted.

 

I simply asked a direct question - no agenda,no hidden meaning,no insults.

Just a question that has now been answered.

Everybody here knows that you are the troll BUSA.

Keep your idiotic opinions to yourself.

Edited May 17, 2015 by David - Moderator

[TakingThePlunge]

Guys,

 

We can discuss this topics without the personal insults and foul language. Let's remain civil.

 

Also, I have had to remove the reference to one Turkish physician to whom we no longer refer on this forum. I don't know why the name was not caught by the auto-moderation system in the first place.

[CaliHairGuy]

The thing that really put me off getting strip is the claim u cannot revert to your normal gym regimen for at least six months. Sod that! I was back to lifting weights within four weeks of my FUE.

 

I seriously don't know where some of you people get your information. I am 18-days post-op with a 3800 graft FUT with Konior and went to the gym yesterday. Did lighter weight than normal, but didn't feel anything on my scar. No tightness. No pulling. Then again, Dr. K said that my laxicity was in the top 80 to 90% of people.

 

One reason i went with FUT is because I wanted a larger surgery with greater yield.

 

Second, the history of Dr. Konior's patients having only a 1mm to 2mm scar was another reason I chose the doctor I did. Hell, there is a thread from Sam Spade (another Dr. K patient) who shaved down to a 1 in back, and the scar could barely be seen. I'm not saying everyone will be able to do that, but it is at least a real example.

 

Third, I wanted the most long term potential for grafts. You can do 1, 2 or sometimes 3 (depending on scalp) FUT surgeries and still have the potential to do FUE. You can't do that process in reverse

 

So, there are some counterpoints to the pro "only FUE" comments that I've read in this thread. With some, it's getting into dogma territory around here.

[scar5]

 

1) ...I am 18-days post-op with a 3800 graft FUT with Konior and went to the gym yesterday.

 

2) ...my laxicity was in the top 80 to 90% of people.

 

3) One reason ...FUT...larger surgery...greater yield.

 

4) Konior's patients...1mm to 2mm scar

 

5) Third...can do 1, 2 or sometimes 3 (depending on scalp) FUT surgeries and still have the potential to do FUE. You can't do that process in reverse

 

6) dogma territory around here.

 

 

Oh... boy

 

You are exuberant and congrats. I know the feeling.

 

Let's go through the points you made. (and I am sure you will get great growth. Here is hoping you a) never wanna buzz, b) don't mind about a thin crown c) have no probs with meds, d) are over 35

 

1) Stupid. You can't feel anything because your nerves have been severed. Do not stretch your neck. Seriously. When and if, in six months, you decide to complain, you lose.

 

2) OK..so they told you that, did they? Guess it was a simple choice. 'Son, you have great laxity, by geebes, let's do a strip..'

 

3) I agree 100%

 

4) Yeah..whatever

 

5) it doesn't matter what you do after strip. You can amputate your limbs. You have blown it, so to speak.

 

6) Dogma?. You want dogma? 'Well, buddy, you have great laxity and you want the maximum number of grafts in future...let's do strip"

[Blake Bloxham]

Scar,

 

Severed nerves? What nerves are you referring to, specifically? Also, what do you mean by thin crown? I'm not following here? If grafts aren't implanted into the crown, what does it matter which method was used?

 

I think Cali's case is a good example of a patient well-suited for strip. Patients will always be better for one procedure or the other. The key is seeing a doctor who will objectively describe the pros and cons of both procedure and provide the patient with true informed consent. I'm very certain Dr Konior discussed both methods with him. He weighed the pros and cons of both, and decided he'd opt for better yield and accept a strip scar. Like you said above, it provided him with a larger surgery with greater yield. These were his goals and he believed strip offered the best shot at achieving them.

 

Like I've said before, it's about performing the right procedure on the right patient. A 24 year old guy who may buzz, wants to wear an undercut, just wants the temple recession filled in for now, et cetera, is an FUE patient. No reason to give this guy a strip scar that could limit his options in the future. A guy like Cali who wants the biggest "bang for his buck" -- with respect to size in one session and growth yield and has no intention of buzzing the sides down probably shouldn't risk 20%-ish less growth with FUE.

 

I think this is fair.

[CaliHairGuy]

Oh... boy

 

You are exuberant and congrats. I know the feeling.

 

Let's go through the points you made. (and I am sure you will get great growth. Here is hoping you a) never wanna buzz, b) don't mind about a thin crown c) have no probs with meds, d) are over 35

 

1) Stupid. You can't feel anything because your nerves have been severed. Do not stretch your neck. Seriously. When and if, in six months, you decide to complain, you lose.

 

2) OK..so they told you that, did they? Guess it was a simple choice. 'Son, you have great laxity, by geebes, let's do a strip..'

 

3) I agree 100%

 

4) Yeah..whatever

 

5) it doesn't matter what you do after strip. You can amputate your limbs. You have blown it, so to speak.

 

6) Dogma?. You want dogma? 'Well, buddy, you have great laxity and you want the maximum number of grafts in future...let's do strip"

 

Ok, let's approach this a different way. But still go through the points,

 

1) The nerve/numbness is an interesting point, although pointed out above that there is a question regarding the nerves being "severed." Dr. Konior recommends no physical activity for 2 weeks after the procedure. He also recommends people sleep with a cervical collar for 6 weeks. I am following both those protocols. In fact, an interesting topic I haven't seen brought up (not that it hasn't) is how much potential stretching of the scar can/could occur when people are sleeping, sometimes in odd positions. I will double check with Tom today to see his insights on going to the gym. Now, regarding certain exercises, I don't think you'd want to do heavy exertion exercises like squats for a little bit longer.

 

2) It was already determined before I got to the office that I would be undergoing an FUT. That was the doctor's comments regarding my scalp after he had pesonally touched it with his golden hands. No mention of Geeves or any other British butler.

 

3) I am 44, and wanted my biggest bang for the buck possible. Also, as I understand things, you can go FUT >> FUE but not FUE >> FUT. So, I decided on FUT (besides all the other points mentioned) because I felt this gave me the greatest options for future procedures and number of grafts.

 

4 (your most eloquest response of the bunch). Dr. Konior's patients have a history of scars in the 1mm to 2mm range. Do you have examples of his patients not within these parameters?

 

5) Have you had either an FUE or FUT? I am just curious. Don't feel like I've "blown it." I have been using a 4 on the sides for awhile. I have never "buzzed" my hair. I am assuming you're talking about a 1 or 2 guard? I also feel once you get a surgery, that you're less concerned about any potential scar. THe same way I got used to having my head shaved for the surgery. At first I was super-concerned. Now it's just a thing. The potential scar line doesn't bother me one bit at this point. And, like I mentioned in 3, (as I understand things) you can go FUT >> FUE but not FUE >> FUT.

 

6) Like I mentioned previously, the laxicity comment was made on the day of my surgery, and would have had no impact on my choice for FUT.

 

Have a good day

[hairweare]

Blake, I think your bias is showing through a bit. Sure when a patient is given the choice between $5 vs. $10 a graft "yield" very likely be higher with the former as who will want to pay $50K to in order to achieve the comparable full coverage? It is pretty much a Hobson's choice for that matter. One shouldn't categorically state that FUSS has an inherent better yield than FUE. Certainly the recent posted cases by Dr. Lorenzo's patients and the ones by Dr. Vories this month would offer a compelling refutation to that hypothesis which by no means is an established fact.

 

I recall the days when docs argued that CABG for heart patients was a better treatment than angioplasty because it resulted in more complete revascularization and better outcomes. While perhaps that was the case during the primordial period of balloon angioplasty, when the technology and experience of the operators advanced that argument became moot allowing the vast majority of heart patients to avoid the knife and subsequent dreaded "zipper" chest. I see the same future for FUSS as patient education and demand will render FUSS obsolete in the near future since in the best of hands FUE has currently achieved credible parity.

[Blake Bloxham]

Weare,

 

I wouldn't call it a bias. To be honest, I think it's more of a necessary balance. Sometimes we get so caught up in these "before and after" results without reading the fine print, that big assumptions are made and then propagated.

 

As far as the evidence is concerned, see this post here: http://www.hairrestorationnetwork.com/eve/178876-costs-fue-us-vs-europe-asia-post2428542.html#post2428542

 

It took me quite a while to find something with actual concrete data, and I'm so glad Dr Wesley and Dr Beehner took the time to do so. As you can tell, this is objective data. Utilizing images is subjective and anecdotal. This is the best evidence I've found so far. It shows better growth with strip. If you have any other concrete, objective numbers, please share them - because trust me, it's lacking!

 

Thank you for bringing up the excellent example of CABG v angioplasty. This makes my point perfectly.

 

Let me propose a series of questions here:

 

You have three patients coming onto your cardiology service with the following diagnostic cath findings. Tell me which ones you would take for angioplasty with stent placing -- the less invasive technique, and which you would refer to CT surg for CABG ("bypass surgery"):

 

1) A patient with 70% stenosis of the LCA (left circumflex artery)

2) A patient with 90% stenosis of the L main

3) A diabetic patient with triple vessel disease

 

Now, unless your institution does it differently, let me explain what the answers would be: 1) cath with stent, 2) CABG, 3) CABG.

 

But cath is less invasive? You see commercials on TV telling you its 100% effective for patients with coronary artery disease. So why send the second two patients for open heart surgery? Because it is the right surgery for the right patient! You, as a cardiologist, evaluated all three of these patients, weighed the pros and cons of both surgeries, and recommended the surgery best suited for the individual patient. This is the exact same thing I'm saying.

 

I understand you had a great experience with Dr Lorenzo. I understand it was MUCH better than your strip surgeries from a long time ago. And this is awesome! He's a wonderful surgeon. But honestly, I do think you're showing a bit of bias here as well. I've heard you make a few comments about Dr Lorenzo and FUE that were far more incredulous than those I've made discussing the two.

 

My point is simple: provide informed consent and perform the right procedure on the right patient.

 

Is this really that biased?

[hairweare]

On the contrary I doubt that it the perfect point you wanted to make! I don't want to lose this largely lay audience by getting too academic but suffice is say that in the late 70's if you had coronary disease your doctor was most likely going to refer you for an invasive operation because there was thought to be no other alternative. Skip ahead 40 years and the only patients being subjected to CABG are the two niche situations that you cited. The vast majority of heart patients are now treated with either medical therapy or a drug eluting stent. CV surgery programs are hurting for trainees and a lot of established CV surgeons are doing cosmetic vein stripping because they are unable to find work opening chests!

 

Now granted this transition did not occur over night just because a Swiss doc figured he could open up a blocked artery with a balloon. Furthermore not all cardiologists performed the procedure the same way or produced the same stellar results as the leading institutions in Cleveland, Kansas City and Rochester. It took time for the technology to evolve and for docs to become better trained in order be first offer an alternative to CABG and then later to massively surpass it in gross volume. I believe we are at the same stage with FUE. The technology has evolved to reach parity but not all physicians use the same technique or utilize the best practices. True I selected Lorenzo based primarily on empiric evidence, but when one consistently sees the ho hum results frequently posted by the strip docs and compares it to his techniques using the same o less number of grafts, it is hard not to be impressed. I am convinced it is only a matter time before the science proves what we are now seeing with our "lying eyes"

[Blake Bloxham]

Weare,

 

Again, I don't want it to seem like I don't like FUE or I'm anti-FUE. I like FUE! I like FUE a lot! I absolutely understand the pros of the less invasive nature and know patients want it. This is precisely why Dr Feller, Dr Lindsey, and I set out to work with the technique and remedy some of the issues I point out above.

[hairweare]

Blake, I looked at your references. As you know a 6 pt. study should not be construed as medical evidence and comparing transection rates from ARTAS to the best case scenario for FUSS is somewhat disingenuous is it not? None of the leading FUE surgeons use ARTAS so why not compare Dr. Vories transection rates to the average HRSN recommended FUSS doctor? Do you really believe that the difference in transection rates would be that far apart?

 

I am anxious to hear about your new contribution to the refinement of FUE but it is only fair when critiquing it's efficacy one considers it's current state of the art or best practice techniques rather that cite dubious methods such as ARTAS of case reports where the methodology may not be the cutting edge (pun intended).

[Blake Bloxham]

Weare,

 

Thanks for taking a look at the references!

 

The ARTAS study is significant for the fact that it's a study sponsored by ARTAS that reported transection rates on that level. This study wasn't subjected to any sort of peer-reviewed critique, so the fact that the rates were still reported at this level is somewhat telling.

 

I believe Dr Vories still uses the NeoGraft to score the grafts, but now delivers the grafts manually. I'm not sure if the average transection rates with NeoGraft are available somewhere, but that would give more of an answer.

 

However, Dr Beehner and Dr Wesley -- to my knowledge -- both extract grafts manually. The data from Dr Wesley showing growth rates is from grafts extracted by "best practice" which, in my opinion as well, is manual tools. So this is much more of an "apples-to-apples" comparison.

 

Again, if you do have anything tangible to review refuting these claims, I really would like to read it.

 

Do I think the transection rates from a top FUE guy and top strip guy differ? Yeah, I still do. I was watching one of Dr Lorenzo's YouTube videos the other day -- and, of course, I can't find the specific one I'm talking about now -- and he quoted his transection rate for that particular surgery at 11%. I also remember Dr Vories saying he will stop the procedure or recommend a different approach if he's seeing greater than 20%. To me, this means anything near that ballpark but still under would be considered acceptable (15%, etc). Dr Feller uses nearly identical criteria during his initial testing before diving into a full-blown FUE procedure. Transection with strip is going to be 2%-ish. So, I think its different -- however, see below for how much this really matters.

 

Keep in mind, however, that transection of grafts isn't the whole story. What's more important, and this was shown by Dr Shapiro in a portion of the Hair Transplantation text, is what happens to the grafts that are successfully extracted -- and, again, this doesn't take grafts that were scored but failed to be extracted into account. FUE grafts are stripped of a lot of the protective supporting material, especially near the hair bulb, and this leads to issues. It also does not touch on the delivery phase, which is where avulsion injury and tension damage is brought into the picture. This is where I think the true difference in yield lies. Now, Dr Vories says this can be overcome by using a Choi/Lion implanter. And this is definitely an interesting theory. And one I'd be interested in reading more about. However -- and I think you'll note the pattern here, this still comes down to personal experience and, to my knowledge, hasn't been studied objectively.

 

Now, here's the important question ....

 

Does this matter? Joe Tillman made a very interesting post essentially stating that the evidence was correct, but it's all much more moot when patients are seeing good results from FUE. Does it really matter if only 80% of the grafts grow if the results are good and the patient avoids a strip scar? Frankly, this is an important consideration and I think it's closer to the point you're making.

 

However, I think this illustrates the difference between the physician's role and the patient's role. The patient's role is identifying their goals, discussing the options with ethical practitioners, and obtaining the best results possible. The physician's role, in my opinion, should be to focus on some of the academic minutiae we're discussing here and always strive to better what's available.

 

Some of these recent back and forth conversations actually crack me up a bit, because I feel like I'm arguing against something I actually support. It's a bit maddening because I've always been a big supporter of FUE. Who wouldn't be? Over the years, however, my perspective changed from that of the patient/observer to that of the physician -- as we discussed above, and I found myself focusing more on these very fine details. Sometimes I think my academic evaluation of these details comes off as "anti-FUE" or "pro-strip," but this isn't the case.

 

I see the potential FUE has and what it offers to hair loss sufferers, and I feel obligated to put it "through the ringer" in a sense, and really work on improving these small areas in order to offer the best procedure to patients. This is the same thing guys like Lorenzo, et cetera, did when they made changes to the protocol. I've been uber invested in this field for years now, and I really feel passionate about combing through each detail and coming up with the best solution in the end. Until we figure out a reliable method of donor regeneration, hair transplantation is a complicated chess game, that involves using a finite number of grafts to really make a big cosmetic difference. In this game, EACH one of those follicles matters. And I want to be able to say I've done my best to preserve and utilize each follicle to the extent of my abilities.

 

In the end, I think this is what our new technique does. It's cool. However, it's a totally new approach and will likely draw a lot of questions and some controversy. I expect this won't be the last long forum post I write about it! Haha. However, I personally believe it's the best way to achieve what I outlined above. To steal a good phrase you used above, I think it combines the best aspects of the two techniques we have available and offers patients our "best practice." We will see what others think!

 

To me, this is ethical and very important in the end.

[BaldingBogger]

With all due respect and you have a very helpful nature Blake and have been a great asset to the forum.

 

i think in your new position and in the interest of objectivity your position as a moderator here should probably be ended earlier. And going forward continue posting as an independent Dr. I appreciate the angle you are coming from and the extensive research you have undertook but a lot of this information is coming across as biased to suit the profile of your new clinic.

 

Without going over old ground at this stage I think a lot of these FUE/FUT old myths have been extensively debunked already. We all know the USA is a unique situation compared to Europe where FUE techs cannot have the same level of involvement. It just strikes me the US clinics are desperately trying to keep FUT on life support. And now to champion small FUE sessions combined with FUT procedures sounds like another gimmick to be honest.

 

I guess we will wait and see though.

[Blake Bloxham]

Small FUE session combined with FUT?? Are you referring to our new FUE technique? The combined FUE/FUT thing has been done many times before. I've never really understood or supported this technique before. This isn't what we're doing here.

 

Thanks for the kind words.

[hairweare]

In fairness to Dr. Vories who can speak for himself, he no longer employs the Neografts system to extract follicles. I believe that he exclusively uses sharp Vortex punches of varying caliber. To my recollection he referenced a 10% not 20% stop loss transection rate and I believe this was also in reference to a Afro-American patient. I asked Dr Lorenzo how he keeps up at such a frenetic pace and when will he call it quits, to which he replied "when I can no longer improve upon what I am doing". I believe I also saw the video with a stated transection rate of 10% but it was from 5 years ago. Somehow I don't think that he would today accept that number as his standard of care.

 

A very important point which seems to be missed and that Joe may have inadvertently made is that the "playing field" for FUE is much larger than it is for strip harvesting and that the surgeon can select 1,2 or multiple hair follicular groups at his discretion. Again, my strip surgeon who was an early advocate of FUE felt that at best he could get only another 500-800 strip grafts from my depleted occipital donor area whereas a skilled and conservative FUE doc having a much larger area to operate in was able to extract 2900 with probably another 750-1000 to spare.

 

Unless you price your FUE procedures at the same rate as strip, your patients are really not getting a fair and balanced discussion as to which procedure to choose.

[wazaam]

 

"I believe Dr Vories still uses the NeoGraft to score the grafts, but now delivers the grafts manually. I'm not sure if the average transection rates with NeoGraft are available somewhere, but that would give more of an answer."

 

Dr Vories does not use the Neograft to score his grafts. He use the C. Vertex Punch which was confirmed by his patient rep. His FUE protocol is quite similar to that of Dr. Lorenzo's.

 

 

"I also remember Dr Vories saying he will stop the procedure or recommend a different approach if he's seeing greater than 20%."

 

This yield figure was in reference to Dr. Vories African-American patients. His clinic guarantees 85% graft survival rate or better.