Another FUT vs FUE thread!

[PupDaddy]

Posters and Doctors can argue all day long until they are blue in the face about yield %'s, it is just semantics. There is no denying the results being acheived through the FUE procedure of which i myself am a beneficiary.

 

Weren't you on this very forum fretting about the poor result you got from your FUE transplant? At 15 months post FUE surgery you started a thread to ask whether you could expect any further growth or thickening of the transplanted hair because you still had a "large, thin area" behind your hairline that had been transplanted:

 

http://www.hairrestorationnetwork.com/eve/173108-15-months-post-fue-will-i-get-more-growth.html#post2372711

 

I'm not trying to bust your chops, but it seems odd that you would so enthusiastically promote FUE and so vociferously malign FUT and FUT docs/clinics when you seem to have experienced first hand the challenges associated with FUE yield and matured density/hair quality.

 

Did you experience a sudden turnaround of your situation after the 15-month mark? (I hope so!) Did you go for a repair or touch-up, as you indicated you might? Could you please post before and after photos of your FUE transplant surgery/surgeries so we can assess your FUE results?

 

Thanks!

[BaldingBogger]

Yes i have been quite open regarding my status, I have now had 3 FUE surgeries in total so unlike a lot of people on here who talk 2nd hand tosh i have first hand experience . I had around 85% yield from my first procedure which my grown in density was measured. People seem to be unaware that you can actually measure grown in yield density.

 

The situation improved post 15 months but there was still a weak area which was attributed to scabbing in 2 small areas which caused lack of growth in which i also mentioned in topics on here. Everywhere else grew in perfectly.

 

The subsequent 2 FUE procedures i think were close to 100% as you can get. I have shared my photos and story with other posters on here offline like Mickey85 at the time. I initially shared pictures on another forum and was recognised which i did not want so i have kept them off here.

 

I dont feel additionally compelled to share them with a Jack Russell if thats OK. I am passionate about FUE cause i got a great result from it. And because certain clinics tried to tell me FUT was all i could get which i just didnt buy.

 

I dont think i am maligning anyone or FUT. I clearly state it gets great results. I am responding to what i see as false information being posted on these forums. I am telling things how it is in my opinion. If you are a fan of a certain clinic or procedure and are offended. Deal with it. We all have our opinions and in this case it is formed from experience.

 

 

I dont really need to be still around here . However I did a lot of research before pulling the trigger and want to pay it forward and try educate prospective patients where possible with some experience. And in this case what i feel is BS propaganda being spread regarding FUE capabilities in the name of the almighty dollar.

Edited June 10, 2015 by BaldingBogger

[PupDaddy]

Interesting. Three FUE procedures. I totally understand that you don't want to be recognized by prying lurkers, but if you can figure out how to mask any identifying features in your before-after photos I think a lot of people here would be interested to see your case -- especially since you ultimately received what characterized as a great result. Your call, of course.

 

Can I ask what your starting Norwood level was and the number of grafts transplanted with each of the 3 procedures? Can you tell us the doc(s ) that performed your procedures?

 

How did you or your doc(s) go about measuring the grown-in yield of your 3 FUEs?

 

How is your donor area now?

 

I'm not offended that you advocate FUE over FUT or that you hold the practices and work of certain docs in higher or lower regard than others. I have no dog in this race. I have some personal favorite docs based on their published results, just as there are some docs whose work doesn't impress or appeal to me as much. Some do primarily FUE, others do primarily FUT, some do good amounts of both. It's just that you seemed remarkably pro FUE and anti FUT (and the docs that offer it) for someone whose thread about his own FUE case indicated a less than satisfactory outcome. Sounds like your two subsequent procedures left you a happy camper. Good!!

 

I do think that the best FUT work still holds a significant edge in consistent yield/density over the best FUE work on visual comparison and that the limited clinical data is consistent with this, and explains why this would be so. But there is some fine FUE work being turned out today that I personally would be happy with as a patient. In fact, as someone no longer in his twenties (or thirties, or . . . ), and whose Norwood level took decades to reach its present IVA and seems fairly stable, I now would likely be an excellent candidate for a large FUE restoration -- unlike, in my opinion, higher Norwood 20-somethings who run a significant risk of prematurely using up their safely extractable donor supply by flying to Turkey for the FUE mega sessions being marketed to them.

Edited June 10, 2015 by PupDaddy
typo

[Blake Bloxham]

Pup,

 

Excellent response above!

[paddyirishman]

Thanks to Dr.Vories on the very useful information regarding graft survival and timing with the use of implanter pens.

 

All the best..................Paddy.

[Blake Bloxham]

Dr Vories,

 

Now that we are on the implanter pens, I do have a few questions I've been meaning to ask -- if you don't mind:

 

As you may remember, I researched the implanter pens a while back and you were kind enough to exchange a few emails about it. I definitely understand the benefit of not handling the dermal papilla (DP) as much and why the most gentle placement technique for skeletonized FUE grafts would be very beneficial.

 

However,

 

1. With the hairs trimmed very short and the bulge stem cell region of the outer root sheath (ORS) of the follicle being closer to the epidermis, is there a chance that this region would be pinched and used to pull the graft into the needle? Technically, the DP, in my opinion, is more important, but studies show that hairs grow thinner and less consistently when the bulge is damaged.

 

2. Are the grafts really touched less, in general, when using the implanter pens? When I think of forcep assisted placement, I think of two points where it is "touched:" picking it up and gently tamping it down after it's placed in the slit. With the pen, isn't it touched once to pull it into the needle, once when it's implanted, and then again to tamp it down -- which seems to be more frequent with the pen method. Wouldn't this be 3 times? Granted, I do understand that it's protected by the outer portion of the needle while it's being placed, so this offers some protection that forcep placement may not.

 

3. How much force does the actual "clicking" implantation method place on the graft? And if the needle isn't placed properly, how much compression/"crumpling" damage can be done to a graft? Have you ever pulled one out after it was placed and looked? I haven't done this with forcep placed grafts, but it's something I've always been curious about.

 

4. What is the chance that the hollow core of the needle isn't perfectly smooth? I know this is something Dr L addressed when he helped design the Lion implanter. However, I can't see how there wouldn't be some small imperfections inside of the needle. Look at this microscopic view of a hollow bore needle here:

 

 

It seems like any of those small imperfections would snag the graft and cause damage. What's more, it would happen twice -- once as it is pulled into the needle and once as it is injected. During my research, I also read that these tend to increase the more the needle is used?

 

5. Is there anyway to damage the graft while it is pulled over the sharp needle itself during insertion into the pen?

 

I've been meaning to ask these questions since we first spoke. Like you said, research and answers to these kind of question is somewhat lacking in the hair restoration world. I appreciate the time and openness!

[Michael Vories, MD]

Atraumatic placing of FUE grafts is the most important topic, in my opinion, in all of hair transplant surgery. It is the reason I use Implanter Pens, and the reason I place all grafts myself. I use technicians, and I could easily delegate this part of the procedure to them. I choose to do this myself not because I do not trust them, but because I believe I owe this to my patients that when they sign up for surgery with me, then I should perform this most critical part of the procedure myself. I do not think most patients understand how easy it is to crush FUE grafts with forceps. Even the most gentle placer can injure the bulb with forceps.

 

So while it is true that FUE grafts can injured with Implanter Pens, they are much less likely to be injured than by forceps placement. The dynamics you describe can harm the grafts, they do not compare to do the damage that can occur with forceps placement. To explain this with words is one thing, to see it is another. That is why I welcome any physician to my clinic to observe the procedure at anytime, at no cost. (With patient approval). So come down to the Carolinas Blake, let me show you why I spend my day in the OR, and not writing HTN posts. Thanks!

[KO]

When it comes down to it, this is basically the whole argument for FUE in a nutshell. People seem desperate to debate the minutia (as well they might/should) but in reality, it seems more and more people (leaving aside issues of candidacy, price and yield) want a less invasive procedure with less cosmetically significant scarring.

 

Choosing a technique is a personal decision, and if one favors FUE due to the decreased scarring, it is an opinion that weights the costs and benefits of each procedure. This debate isn't about that, it's about the objective costs and benefits (yes the minutia) of each surgery. FUE is more popular, no doubt, but what is "more popular" doesn't really answer the question of what's going to give patients the best result. For all you know, there's patients who prefer the better yield and aesthetic appearance that comes with FUT, they will never cut their hair short enough to reveal a FUT scar, so why would they bother with FUE? Is Jotronic bothered by his scar? How about voxman, or Matt1978?

[KO]

Dr Vories, do you know of any other surgeons using the Lion Implanter? I know Juan Couto also in Madrid uses an implanter, not sure if it is a Choi though.

 

Dr Couto would be a good addition to this forum too. *Cough*

[Michael Vories, MD]

I am sure there are many physicians who use the Lion Implanters, but I know of only Dr. Lorenzo and myself who use them consistently. I like them because they stay very sharp during the course of the procedure, and minimize graft popping.

[thatoldchestnut]

Choosing a technique is a personal decision, and if one favors FUE due to the decreased scarring, it is an opinion that weights the costs and benefits of each procedure. This debate isn't about that, it's about the objective costs and benefits (yes the minutia) of each surgery. FUE is more popular, no doubt, but what is "more popular" doesn't really answer the question of what's going to give patients the best result. For all you know, there's patients who prefer the better yield and aesthetic appearance that comes with FUT, they will never cut their hair short enough to reveal a FUT scar, so why would they bother with FUE? Is Jotronic bothered by his scar? How about voxman, or Matt1978?

 

I think you may have misunderstood me. I didn't seek to address any of that, merely offered an observational truism. It wasn't me putting forth an argument for FUE. I certainly think the patients you mention have had excellent FUT results and I noted that the minutia is inherently worth debating.

 

All i sought to elucidate (if it even needed clarifying, hence truism) was that, time and time again, people refer primarily to the relative scarring of FUT/FUE as a means of justifying their preference. Not really sure why you'd attempt to rebut what is quite clearly a neutral statement of fact with (arguably fallacious) conjecture.

[JohnArbuckle]

Dr Vories,

 

Now that we are on the implanter pens, I do have a few questions I've been meaning to ask -- if you don't mind:

 

As you may remember, I researched the implanter pens a while back and you were kind enough to exchange a few emails about it. I definitely understand the benefit of not handling the dermal papilla (DP) as much and why the most gentle placement technique for skeletonized FUE grafts would be very beneficial.

 

However,

 

1. With the hairs trimmed very short and the bulge stem cell region of the outer root sheath (ORS) of the follicle being closer to the epidermis, is there a chance that this region would be pinched and used to pull the graft into the needle? Technically, the DP, in my opinion, is more important, but studies show that hairs grow thinner and less consistently when the bulge is damaged.

 

2. Are the grafts really touched less, in general, when using the implanter pens? When I think of forcep assisted placement, I think of two points where it is "touched:" picking it up and gently tamping it down after it's placed in the slit. With the pen, isn't it touched once to pull it into the needle, once when it's implanted, and then again to tamp it down -- which seems to be more frequent with the pen method. Wouldn't this be 3 times? Granted, I do understand that it's protected by the outer portion of the needle while it's being placed, so this offers some protection that forcep placement may not.

 

3. How much force does the actual "clicking" implantation method place on the graft? And if the needle isn't placed properly, how much compression/"crumpling" damage can be done to a graft? Have you ever pulled one out after it was placed and looked? I haven't done this with forcep placed grafts, but it's something I've always been curious about.

 

4. What is the chance that the hollow core of the needle isn't perfectly smooth? I know this is something Dr L addressed when he helped design the Lion implanter. However, I can't see how there wouldn't be some small imperfections inside of the needle. Look at this microscopic view of a hollow bore needle here:

 

 

It seems like any of those small imperfections would snag the graft and cause damage. What's more, it would happen twice -- once as it is pulled into the needle and once as it is injected. During my research, I also read that these tend to increase the more the needle is used?

 

5. Is there anyway to damage the graft while it is pulled over the sharp needle itself during insertion into the pen?

 

I've been meaning to ask these questions since we first spoke. Like you said, research and answers to these kind of question is somewhat lacking in the hair restoration world. I appreciate the time and openness!

 

Bumping this old thread to note that this is an incredibly insightful post.

[Edsarn2017]

Atraumatic placing of FUE grafts is the most important topic, in my opinion, in all of hair transplant surgery. It is the reason I use Implanter Pens, and the reason I place all grafts myself. I use technicians, and I could easily delegate this part of the procedure to them. I choose to do this myself not because I do not trust them, but because I believe I owe this to my patients that when they sign up for surgery with me, then I should perform this most critical part of the procedure myself. I do not think most patients understand how easy it is to crush FUE grafts with forceps. Even the most gentle placer can injure the bulb with forceps.

 

So while it is true that FUE grafts can injured with Implanter Pens, they are much less likely to be injured than by forceps placement. The dynamics you describe can harm the grafts, they do not compare to do the damage that can occur with forceps placement. To explain this with words is one thing, to see it is another. That is why I welcome any physician to my clinic to observe the procedure at anytime, at no cost. (With patient approval). So come down to the Carolinas Blake, let me show you why I spend my day in the OR, and not writing HTN posts. Thanks!

 

It would be great to see a discussion between Drs Vorries and Feller regarding FUE, but like Dr Vorries mentioned, he's too busy in the OR to spend time on HTN. I wonder if his offer was ever accepted?