Cast your vote FUE OR STRIP and were

[1978matt]

You look at the census results from 2013 from ISHRS? Well first of all it's 2015.

 

Secondly it's N=161 only under ISHRS members. Not a really good representation is it?

 

Open your eyes go to independent inter(national) forums and look in the hair transplant sections. Here start with this forum for example (translate it);

Chirurgische behandelingen - Haarweb Forum

 

Really goddamn hard to even find a FUT topic isn't it ? And now go to other forums and look for yourself.

 

Is it hard data? No , but probably is indicative of what people look for/want!!

 

People want a less invasive procedure and don't want a scar. It's that simple. Come on it's goddamn 2015. In the end consumers dictate the market anyway.

 

The last available census is from 2013 otherwise I'd use 2015, and so what if it is ISHRS survey? It's likely to be far more accurate than just looking at Forums.

 

Europe has seen the biggest increase in both patient numbers and FUE so I would not be surprised to see a lot of FUE results from places like Turkey, Holland, Germany and Belgium. The sort of guy who posts online is likely to be younger. Younger means FUE, so I am agreeing with you that there won't be many FUT cases posted on those forums. But does that mean FUT is going to die out completely? I don't think so.

[paddyirishman]

fue.......................europe........................

 

 

[Blake Bloxham]

Interesting thread. I'm not too surprised by the results either. Seem fairly split. This is what I see when evaluating the entire hair transplant patient population as a whole. But more about that in a minute.

 

It's an interesting concept to ask patients what they would "want" and why. I assume all patients would want some sort of donor doubling procedure, performed a few blocks away from their house, with 100% yield, no scarring, and discount prices! However, this isn't reality. This is true for both of the options we have available today as well.

 

There are going to be some patients who are better suited for strip and others better suited for FUE. Sometimes, patients who are better suited for strip still don't want to undergo strip and will push for riskier big FUE procedures or multiple FUE procedures over YEARS to avoid the scar. As long as they are aware of the risks and benefits, this is fine. However, the results will be more variable than if they had undergone strip in the first place. Most patients seem to understand this and come to terms with the fact that for high NW patients who want the best yield/hair characteristics are going to be better served by strip. These are the guys who really want "hair restoration" and dive in. The others are the ones who seem to talk more about the scarring in the donor than they do about the hair in the recipient. They are the guys who are okay with a failed procedure or subpar yield as long as they have the option to shave. Again, as long as they are properly consented, this is fine. It's not what most would probably recommend, but no one should force a procedure down these patient's throats if the linear scar is a true deal breaker.

 

So, how I would break up the voting?

 

Patients who need a lot of grafts, patients who are > NW3-4, patients who really want to get the "wow" results and move on with life should cast their vote for strip. Europe, NA, India, etc all have great strip surgeons.

 

Patients who aren't as concerned about the restoration in the front, are okay with the final result taking 3-5 sessions over 3-5 years, patients who only need a small number of grafts, and young guys who may shave their head should probably cast their vote for FUE. Now, I don't try to insult when I say "guys who aren't as concerned about the restoration in the front." But if you read the threads and or listen to the consultations, it's accurate. And, again, nothing wrong with this. As long as everything is laid out on the table. There are good FUE surgeons all over the place too. Now, I do take issue with some of the technician FUE procedures where 3,000 - 6,000 grafts are extracted in a number of hours and packed into a very small area -- which makes growth yield nearly a moot point. However, most of the guys, even the ones with high tech involvement, who really supervise or get their hands dirty don't really subscribe to this model.

 

There now, however, exists a third option: mFUE. This procedure set out to marry the two patients I outlined above: guys who want the "damn" factor of strip results in a timely manner with NO linear scar. Frankly, I think this is the "have your cake and eat it too option." But I suppose time will tell!

[Blake Bloxham]

Swoop,

 

Yeah, I think the most recent data shows about 60:40. However, FUE is up exponentially from a few years prior. Patients definitely want the less invasive option. However, I've wondered if the data is a comparison of straight number of procedures performed or if repeat procedures are taken into account? For example, if one patient undergoes 2 FUE procedures 8 months apart during the study and one undergoes 1 strip procedure, is it counted as 2 FUE procedures and 1 strip procedure, or 1 FUE patients versus 1 strip patient? Regardless, patients will always want the less invasive option. This is true for all aspects of medicine and surgery. This doesn't always mean it delivers the best results, but some patients are fine -- or more than fine -- with this. As long as they are properly consented, it's all good.

 

However, there is a very interesting dichotomy that exists between the HT community online and what happens within the walls of an HT clinic. I've been fortunate to experience both on a very involved level and it's really changed my perspective on a lot of things. Now, some may say my informed perspective is motivated by other reasons, but I think the peepz who have gotten to know me a bit over the years understand that I'm pretty objective and open out this stuff. I've put way too much into this field to just "sell out." Haha.

 

Anyway, I think most online would probably be surprised to see the number of patients who either want strip or are on the fence. A lot of guys do research online, decide to go with strip, and their consultation consists of: "when can I book?" However, these people don't post on the forums. In fact, I had a guy recently send me some images and ask for an opinion. He was young and didn't require many grafts, so I said you could do an FUE procedure of X number of grafts to fill in these ares and here's why. He messaged me back and basically said, "I wasn't asking about what procedure I should do; I want strip. I was asking where I should get it done." Obvious N = 1, but it was funny and I see much more of this the more time I spend at the new practice. However, we rarely see that on the forums.

[mav23100gunther]

Swoop,

 

 

Anyway, I think most online would probably be surprised to see the number of patients who either want strip or are on the fence. A lot of guys do research online, decide to go with strip, and their consultation consists of: "when can I book?" However, these people don't post on the forums. In fact, I had a guy recently send me some images and ask for an opinion. He was young and didn't require many grafts, so I said you could do an FUE procedure of X number of grafts to fill in these ares and here's why. He messaged me back and basically said, "I wasn't asking about what procedure I should do; I want strip. I was asking where I should get it done." Obvious N = 1, but it was funny and I see much more of this the more time I spend at the new practice. However, we rarely see that on the forums.

 

Hi Blake, your argument above is very flawed. I believe your clinic quotes around 9 or $10 a graft for FUE as stated on your website. Therefore I hate to say it, but the patients that really want FUE are not bothering to consult with your clinic, and why would they when they can pay less than 3 Euros per graft for high quality results in Europe and Turkey. I guess that shows people aren't really as stupid as some might think. Therefore it doesn't surprise me that the majority of patients showing up on your doorstep are considering FUT. Have you and Dr. feller tried to quantify the opportunity cost of those lost patients you may derive business from if you lowered the FUE fees?

[Blake Bloxham]

Mav,

 

Yeah, situations like this are always influenced by a variety of factors.

 

However, the breakdown of patients asking for FUE versus strip is still roughly equivalent to the ISHRS breakdown: around 30-40% of the consultations are FUE patients. What's more, Dr Feller has said many times that he could easily stop doing strip and convert solely to FUE and still have a waiting list. So I don't really have an exact answer as to why they would pay X rate for services versus going elsewhere when it's cheaper, but they would. And Dr Feller turns down FUE cases he doesn't feel are appropriate all the time. These patients are willing to pay a high rate for grafts to undergo surgery with him, and he doesn't do it because it's not the right way to do it. People say that patients are "leaving the US droves" to seek FUE elsewhere. It would be interesting to show them the number of people who are aware of the prices of US FUE, aware of the prices of foreign FUE, and still ask for FUE in the US. Like I said before, he could stop doing strip tomorrow and still have a waiting list for FUE. Trust me, haha!

 

I know people think it's "all about the money," but Dr Feller is a straight shooter and a very legit guy. He sticks with what he thinks is right and doesn't stray from it.

 

Also, keep in mind that "there is no such thing as a free lunch." If someone is charging a very low price for something, always ask why. Grafts are finite, and undergoing VERY large procedures where non-physicians extract as many grafts as possible from as many patients a day to turn a healthy profit with these low per graft prices is a risky endeavor.

[Patriot34]

FUT, better long term look. FUE typically results in thinning in back of the head that looks very unusual. But this is a case by case and depends on the patient.

 

I have seen some amazing cases out of Europe/Turkey, but I think the same level of skill can be found in US and Canada. Just have to go to the right doctor who knows how to plan for the longevity of a patient.

[Sethticles]

unsure how anyone can say FUT is better for long term look, when you'll be left with a massive ugly looking scar which will be revealed later in life or if not sooner

[Blake Bloxham]

Seth,

 

No reason why the scar would be revealed unless there was massive thinning in the donor region or the patient chose to shave their entire head below a 3 guard. If the former happened, the patient was never a candidate for hair transplantation in the first place. In the second instance, I don't think men who undergo big strip procedures want to shave this low, especially when they're older.

 

There are pros and cons to both approaches. Strip generally provides better growth yield with more natural hair characteristics. FUE provides better cosmetic scarring in the donor region. Patients have different goals, and one approach may help them achieve these better than another.

[Sethticles]

So Blake what you saying is and correct me if I'm wrong here, a scar would be revealed unless you maintain a full thick donor area, so name one FUT surgeon that can ultimately predict the future of patience future hair loss.

 

Secondly you said Strip generally provides better growth yield with more natural hair characteristics. The term " generally " is just the typical way a saying, "we think FUT is better cause we say so."

 

Thirdly you said, I don't think men who undergo big strip procedures want to shave this low, WOW you are correct, no one who has a FUT FUE HT wants to shave at all, thats why we have the HT in the first place, but at some point a lot of us have no choice in the matter, but the positive side to this argument is that all FUE HT can have the choice FUT cannot.

[mav23100gunther]

 

Thirdly you said, I don't think men who undergo big strip procedures want to shave this low, WOW you are correct, no one who has a FUT FUE HT wants to shave at all, thats why we have the HT in the first place, but at some point a lot of us have no choice in the matter, but the positive side to this argument is that all FUE HT can have the choice FUT cannot.

 

Buddy, it's not all doom and gloom for former FUT patients wanting to shave down. People are quick to forget that one could get FUEs into the scar or SMP.

[Sethticles]

The fact that you need FUE to fix FUT is priceless thanks

[Blake Bloxham]

Seth,

 

All hair transplant surgeons should be able to say that you won't thin in the safe donor region. A patient who thins in this area wasn't a candidate for hair transplantation in general. This is why we extract from this region.

 

It's not me saying strip has better yield "because I say so." There is research backing my claims. Feel free to review it here: http://www.hairrestorationnetwork.com/eve/178876-costs-fue-us-vs-europe-asia-2.html#post2428542

 

Yes, being able to shave down in the donor region with less visible scarring is one benefit of FUE. However, some patients would rather take the linear scar in exchange for the benefits I discussed above. Others would rather sacrifice some of the above and retain the option to shave down. It comes down to patient preference and their goals.

[Sethticles]

I just don't see any FUT benefits to any new candidates for a HT, those who already have had FUT and want to "fix" their scar is great, finally something these poor bastards can look forward to, but for newbies out there, there is little point having FUT, especially those blokes out there who are heading towards NW5 or 6 zero point having FUT. The only argument that I see on this site is cost, but with research and a plane trip FUE is sometimes cheaper than FUT in 1st world countries.

[KO]

 

People want a less invasive procedure and don't want a scar. It's that simple. Come on it's goddamn 2015. In the end consumers dictate the market anyway.

 

You're just making an argument that FUE is more popular. No kidding, nobody likes to get their head cut open and it's cheap thanks to Turkey. Anyone can get an HT (Anyone can also give an HT!). But "People don't want a scar" doesn't really refute the key advantages of FUT - of yield, illusion of density, and overall appearance.

[FUE2014]

But "People don't want a scar" doesn't really refute the key advantages of FUT - of yield, illusion of density, and overall appearance.

 

I think FUE has narrowed that gap though which is one of the reasons why it is so popular now. The Belgium docs in particular who practice FUE and FUT have shown some beautiful FUE results, maybe not quite as spectacular as the best ever strip results, but still right up there. Dr Feriduni's FUE is so good the only reason I personally would have elected for Strip with him would have been to save $4000.

[thatoldchestnut]

You're just making an argument that FUE is more popular. No kidding, nobody likes to get their head cut open and it's cheap thanks to Turkey. Anyone can get an HT (Anyone can also give an HT!). But "People don't want a scar" doesn't really refute the key advantages of FUT - of yield, illusion of density, and overall appearance.

 

You're absolutely right - much in the same way that the factors you denote can't be used to refute the key advantages of FUE (they simply highlight its disadvantages and vice versa).

 

You mentioned yourself that it was about objectively weighing the pros and cons and making an informed decision, I'm all for that approach. Asking laypeople (not that you are specifically guilty of this KO, just a general statement) to prove/disprove something that in my mind can only be demonstrated satisfactorily through objective scientific study is an utter waste of time.

 

It seems these debates almost always follow exactly the same format.

 

"But, the scar!"

 

"But, the Yield!"

 

"FUE yield is as good or almost as good as FUT!"

 

"Prove it! We've proven FUT yield!"

 

Etcetera, repeat ad nauseum. It all just devolves into people voicing their own preferences which is fine in and of itself but does little to advance the discussion.

[KO]

You're absolutely right - much in the same way that the factors you denote can't be used to refute the key advantages of FUE (they simply highlight its disadvantages and vice versa).

 

You mentioned yourself that it was about objectively weighing the pros and cons and making an informed decision, I'm all for that approach. Asking laypeople (not that you are specifically guilty of this KO, just a general statement) to prove/disprove something that in my mind can only be demonstrated satisfactorily through objective scientific study is an utter waste of time.

 

It seems these debates almost always follow exactly the same format.

 

"But, the scar!"

 

"But, the Yield!"

 

"FUE yield is as good or almost as good as FUT!"

 

"Prove it! We've proven FUT yield!"

 

Etcetera, repeat ad nauseum. It all just devolves into people voicing their own preferences which is fine in and of itself but does little to advance the discussion.

I agree, and mostly these arguments seem hypocritical to me. All of these claims being argued are basically unverifiable, but why challenge the other side to "prove" something when the side you are arguing is just as tenuous? (something both sides are guilty of).

 

Maybe it is because we have so much emotionally invested in this process?

[KO]

I think FUE has narrowed that gap though which is one of the reasons why it is so popular now. The Belgium docs in particular who practice FUE and FUT have shown some beautiful FUE results, maybe not quite as spectacular as the best ever strip results, but still right up there. Dr Feriduni's FUE is so good the only reason I personally would have elected for Strip with him would have been to save $4000.

 

 

For sure it has, and Feriduni is a master of both. All I am trying to point out is that neither technique is without its pros and cons. Best part is, when Feller and Bloxham discuss their new technique, they get blasted for suggesting that FUE has disadvantages. FUE is great, but FUT too has its advantages...

[Spanker]

There are soooo many variables to this question that to answer it with no further information would be like pinning the tail on the donkey while blindfolded.

 

Take your pick.

[Mickey85]

For sure it has, and Feriduni is a master of both. All I am trying to point out is that neither technique is without its pros and cons. Best part is, when Feller and Bloxham discuss their new technique, they get blasted for suggesting that FUE has disadvantages. FUE is great, but FUT too has its advantages...

 

Definitely. However I feel certain parties(not you KO) are going out of their way to demote FUE to some expiremental and and unproven method, which is certainly is not.

[Swooping]

Swoop,

 

Yeah, I think the most recent data shows about 60:40. However, FUE is up exponentially from a few years prior. Patients definitely want the less invasive option. However, I've wondered if the data is a comparison of straight number of procedures performed or if repeat procedures are taken into account? For example, if one patient undergoes 2 FUE procedures 8 months apart during the study and one undergoes 1 strip procedure, is it counted as 2 FUE procedures and 1 strip procedure, or 1 FUE patients versus 1 strip patient? Regardless, patients will always want the less invasive option. This is true for all aspects of medicine and surgery. This doesn't always mean it delivers the best results, but some patients are fine -- or more than fine -- with this. As long as they are properly consented, it's all good.

 

However, there is a very interesting dichotomy that exists between the HT community online and what happens within the walls of an HT clinic. I've been fortunate to experience both on a very involved level and it's really changed my perspective on a lot of things. Now, some may say my informed perspective is motivated by other reasons, but I think the peepz who have gotten to know me a bit over the years understand that I'm pretty objective and open out this stuff. I've put way too much into this field to just "sell out." Haha.

 

 

Yes, Blake; ISHRS 2015 Practice Census Infographic | International Society of Hair Restoration Surgery. I guess we'll know soon how the numbers are currently or do you have them? Yeah I don't know actually how these surveys are taken exactly, there isn't in much depth data. Nonetheless you can obviously see the trend going up heavily for FUE.

 

I know that FUT is more stable, consistent than FUE. However in the comparison of a top FUE practitioner vs a top FUT practitioner. I believe this is small. Let me give you a example which doesn't reflect reality just my opinion;

 

FUT top practitioner = 95% yield average / low 85% / high 98%

 

FUE top practitioner = 90% yield average / low 80% / high 95%

 

In both cases the risk of total failure is there obviously with very low yields, this is the risk of surgery after all.

 

I do believe however that if we compare the average FUE practitioner vs the average FUT practitioner the difference will be bigger. Where the average FUT practitioner will still probably have a good yield average and not a high variability you are going to literally gamble with your yield with the average FUE practitioner. I feel that you can "slack" more with FUT for obvious reasons. Do you agree somewhat with this all?

 

Yes you are right of course nobody online of the HT community has a good sense of ANY doctor his results. Independent patient results are scarce and we simply don't have access to any doctor his full portfolio of patient results. Which doctor is going to showcase his sub-par results anyway? Nonetheless I believe that a top FUE practitioner will concur somewhat along the lines I just portrayed. I would have no problems going into a conversation with a top FUE practitioner and discuss this point. Even Feriduni states on his website that the difference is small and he is very good at both methods.

 

However what the best method is and what people want is a different thing. There is no doubt that FUE is gaining in popularity you can see it in the numbers and on the forums Blake. I do think that the forums give a fair indicative representation. Much people look online to base their decision on. FUE has the advantage of not a linear scar and being a less invasive procedure. Something that supposedly is very important for many people. Even if informed correctly many people still want to take the FUE road. Instead of discussing the tiring FUT vs FUE point this brings me up to something far more important;

 

Isn't it goddamn time though that the hair transplant industry starts to move along? FUT is almost getting ancient. Therefore I applaud your effort with mFUE. Is it going to work? I don't know. I sure do hope so you will attain stellar results with the procedure where minimal to zero scarring is present. Because in this case A you cope with the personal wish of the patient (no scarring, less invasive) B you maintain the best result possible for the patient. Although again I do think currently in the case of a top vs top practitioner this difference isn't big who is both very good at both methods.

 

Nonetheless my point was here to display popularity and FUE in my opinion has definitely already overthrown FUT and this trend will continue until FUT will become just a "alternative" niche procedure. Because you know Blake a doctor can jump as high as he wants but eventually consumers are going to dictate the market.

[KO]

How did you come up with those numbers of 95% FUT and 90% FUE?

[Blake Bloxham]

Swoop,

 

I wish I had access to the 2015 data! I'm not that cool. Haha.

 

I understand what you're saying when comparing the "top to the top." I also agree that there will be a BIG variation between middle of the road FUE guys versus middle of the road strip guys.

 

However, I do think the average numbers are a little off. I've still never seen any data showing the "top" guys achieve 90% yield. Especially not as an average. I actually heard quite a shocking figure from a very well known FUE-only guy -- 75% -- but I think it's probably somewhere between 75-80% on average, with good yield being in the low 80s.

 

Now, here's the important part: how big of a difference that makes in the long run. Some people will say 95%+ compared to 80%+ won't matter in the end. I disagree.

 

I also think it's inevitable that patients will want a less invasive approach. This is true for any type of medical/surgical procedure. However, if you look, historically, at surgical procedures that started off invasive and then a less invasive approach was designed and pushed as a complete take-over of the prior procedure, there often tends to be too many patients pushed into the less invasive, an outcry from the surgeons, and then a equilibrium. If you look at laproscopic versus open abdominal surgeries, transvaginal versus abdominal hysterectomies, roux-en-y gastric bypass (full bypass) versus the gastric sleeve, et cetera, there has always been this pattern: start off more invasive, someone designs a less invasive technique and recommends it to all, everyone does the less invasive for a while, studies come out and surgeons advocate for different things, and we find a balance where both exist and both are offered to the RIGHT patients because NO TWO patients are the same.

 

Now -- and thank you for the kind words -- marrying the two worlds is something a bit more rare. And, frankly, I think it's what we've done with mFUE. I do believe there will still be a role for strip and some patients will still want traditional FUE, but I really see mFUE as a coda for this whole debate. I'm very excited to keep pushing it forward!