FUT is more popular than FUE

[Blake Bloxham]

and to be honest, the only merit of FUE is no strip scar and in every other category there is a potentially lower ROI than with FUSS to varying degrees

 

Hmm. If only someone would invent a procedure that capitalized on the ROI of FUSS without the linear scar

 

 

What's funny about all of this is that I've seen some doctors that were FUSS exclusive at one time and they didn't exactly inspire confidence with their work. Several years later their FUE work is unquestionably much better than any FUSS work they ever performed. Does this mean they just have a natural talent for FUE compared to FUSS? Or does this mean that FUE has better yield?

 

I think this means that they aren't the ones doing the FUE. It's probably all technicians. This would actually cause me concern.

 

Also, I think you stated in the above post that "FUE grafts will have a lower overall yield," so I don't think that's what would be occurring in a scenario where a physician had poor strip results but good FUE results. Again, I think it means he/she isn't doing the surgery.

[JoeTillman]

Joe,

Nope. Strip grows better than FUE. Period. No parsing of words.

 

This is a bold statement. So, by the bluntness and undeniable point of this statement, you're saying that any FUSS procedure you have performed that did not have good yield would have had worse yield with FUE. You said there is no parsing of words in your statement so this means that it is blanket, without fail, without exception with no room for analysis of your intended meaning, that under no circumstances would an FUE procedure ever have a better yield than any FUSS procedure, regardless of that FUSS procedure having low or high yield. With all due respect, Dr. Feller, this crosses over from being logical to being nothing more than wishful thinking, in my opinion, because that would mean that every single low yield FUSS case ever performed, that went to have FUE for repair, turned out worse than the previous FUSS procedure itself. If you believe this to be true I respectfully say that you are flat out wrong.

 

The minor yield issues are not going to convert pro-FUE readers into anti-FUE and pro-FUSS readers. At most I think it may soften the perception of FUSS for some, which would be a good thing, but my point is this. FUE has gotten to the point, again assuming better quality clinics, that the diferences in yield are inconsequential for most patients.

 

And this is what reminds me of the battles I used to wage online years ago. Back then, it wasn't so much about FUE vs. FUSS. It was more about the Lateral Slit Technique vs. needles, or Choi implanters, or whatever. I would spend HOURS learning about each technique and posting what I felt were logical points against anything that was not the coveted Lateral Slit Technique. But then something changed. I realized that no matter how right I was, and I was right by the way, to this day;) there were still great results being realized by clinics that did not use the LST. How could this be? They weren't using custom cut blades that produce FAR less physical trauma to the tissue. They weren't shaving the recipient zone before surgery so they can see each and every native hair growing in their true angle and direction. But yet there they were. Great growth, great density and more importantly, a happy patient. Well EFF me!

 

I realized, and this was a hard fact to swallow, that these little details just don't matter in the overall picture. These little details that we "experts" bitch about on these forums means exactly two things to the happy patient. Jack and sh*t. And it is the same thing with these academic discussions of better FUE vs. better FUSS. It can be said, easily in fact, that FUSS is indeed more "popular" than FUE but I think it is a disengenious slant because FUSS was already the overwhelmingly dominant procedure when FUE first gained moderate recognition for what it is. This industry is slow to change, and Dr. Feller knows just how slow it is. Microscopes of all things were not used by everyone, including Dr. Feller, from the start and in fact, for MANY years, a lot of doctors were very resistant to their use instead of the tradtionally used jeweler's loupes.

 

I think that FUE is more poplular if we based "popularity" on the growth curve or even based it on which one is growing and which one is not. According to one presentation given at the ISHRS conference in 2010, FUSS procedures peaked in 2008 and have been in decline ever since, with the FUE adoption rate gaining momentum every year. In 2004 FUE made up 7.2% of all procedures performed by ISHRS members. In 2008 it made up 10.8% which is less than 1% growth per year. In 2013 it was over 30% which shows an exponential increase in adoption year over year between 2008 and 2013 (when the last stats were published on the matter). At that rate it means that roughly half of all surgeries performed will be FUE in the next couple of years. So "popular" is one angle, "fastest growing" or in this case, "growing vs. shrinking" I think is more appropriate.

 

The reasons why it is more popular, or gainining in popularity while FUSS is losing in popularity (it doesn't really matter which way you say it) are not because of the superior yields of FUE. We both agree on this and I wrote an article on the driving force of this change, which is economically based, nothing more. But the economics go beyond the ease and low financial threshold behind FUE adoption rates. The economics are ultimately driven by market demand which brings us to the final point, regardless of yield discussions, regardless of confluence of scar discussions or surface area of this,that or the other. The market doesn't want a FUSS scar and FUE eliminates this and as long as FUE yield is close enough, and yes in some cases superior for any number of reasons in some cases, then FUE will continue to grow in popularity and FUSS will continue to decline.

[Mick50]

Thanks Dr Feller for your best wishes, must be cool for your patients to have a Doc who's actually had a successful hair transplant, being a Norwood 5 I have modest expectations but yes having hair again is a good feeling, in an ideal world maybe it shouldn't make any difference to one's self image or how people perceive us, but hey that's a whole new thread ,and since when has it been an ideal world.

[JoeTillman]

I think this means that they aren't the ones doing the FUE. It's probably all technicians. This would actually cause me concern.

 

Which would cause you concern? Technicians doing the procedure or them doing a better job than the doc that used to perform FUSS? Regardless, by Dr. Feller's own words it doesn't matter whom is doing the procedure as he just said that FUSS gets better yield than FUE "PERIOD". Do you agree with this statement, that in no scenario will FUE have a higher yield than a FUSS procedure? I'd like to say that there was room to wiggle on this but there isn't because Dr. Feller just removed all options for wiggling. That just seems weird to type:) but you get the point.

 

I stand by my statements, FUSS will have an overall higher yield but I don't think the difference is very high in better hands and certainly not 40% different as Dr. Lindsay stated but I KNOW of cases where FUSS was the primary procedure and subsequent FUE procedures provided better yield. I know it happens. I've seen it. I've spoken to the patients so it is undeniable to me. It is a fact.

 

Now, the other question is one of consistency. Ah HA! But THAT, my friends is another story, and discussion, entirely.

[fortune11]

Joe has a very valid point about patient demand , and it is hard to argue with that .

 

In my opinion, why patient demand is trending the way it is has a lot to do with age . Now , below is just based my casual browsing of forums over the years so please don't ask me to provide with exact %s and statistics , I don't have any and I am not an expert . I also don't have any affiliation with any doctors.

 

If you look at the hair transplant cases from the 2000s and late 90s what do you see ? Mostly high norwoods , older patients with money, mostly in the US and UK . Younger people in their 20s couldn't afford an HT surgery. Consequently , the need for higher number of grafts . Older patients are also unlikely to shave their heads and they value every single graft .

 

Fast forward to now -- who are the HT patients ? A lot younger . A lot more global. Low NW cases . Filling in temples . Thickening their hairline so they can look perfect on that night out on the town w/ their buddies. It is cheaper and affordable. And more mainstream now , as more and more celebrities as known to have (soccer stars in Europe etc. ) . In that sense, for a young guy, it has become more of a "touch up " cosmetic surgery without the headache of having to avoid the gym for weeks (as with FUT) and without the need to grow their hair longer .

 

Myself , an older patient in 40s, personally have had successive FUTs and will have an FUE as my last procedure . Given my state of hair loss (diffuse bordering on NW6), this was what I found appropriate for me . But if I was a young patient needing a "touch up " , would I go for an FUE right away ? Maybe yes.

 

But then again, what is a "touch up" need today can quickly turn into a full scale restoration job as your hair keeps falling over the years. This is especially true of some young patients who dont want to go on a regular medication regimen as they get scared (rightly or wrongly so) of the perceived sexual side effects.

 

For the younger patients who want the "optionality " of being able to shave their heads , there is this blunt and obvious fact -- not all of you will look good with a shaved head as the rest of your body ages and your waistline expands . You expect to be as fit as you are now in your 40s and 50s and many of you will be , but a lot of you will hate that shaved look and you will wish why didn't I save my donor for a bigger HT.

[Dr. Alan Feller]

... you're saying that any FUSS procedure you have performed that did not have good yield would have had worse yield with FUE..

 

Yes, that is exactly what I am saying, Joe.

[tommygun]

I would like a definition of what "popular" means in the context of this thread. Also, if cost were the exact same, how many people would actually choose a strip procedure if they made the decision on their own accord (not sold on one procedure over another by an employee of a clinic)?

[Dr. Alan Feller]

You know, Mick, you hit on something in your post. You wrote:

 

"... in an ideal world maybe it shouldn't make any difference to one's self image or how people perceive us".

 

I find HT is rarely for others as much as it is for the person himself. I believe HT is really about "identity" and not so much "vanity". And I don't mean vanity in a bad way.

 

I have a friend who is as non-vane as you can get. He was already becoming a stage 5 hair loss sufferer but legitimately was not bothered by it. So when all my friends who needed transplants got them, he wouldn't even consider it. Until one day he came up to me and said he wanted one. I was truly floored. He had told other friends of ours that he wanted it and they were floored as well. What had changed? I had to ask.

 

He told me. And I quote: " I really didn't care about my hair loss until I looked in the mirror and saw my father staring back at me. I wasn't me anymore. "

 

I think that says it all and why the HT industry is huge. It is all about identity, not so much vanity. I feel the same way about myself. When I saw my forehead "growing" it wasn't "me" anymore. So I did something about it and that's how I got into the field.

 

Unfortunately, the doctor who did my first transplant did not do a good job and wasted some of my donor area I sorely need now. Perhaps that is one reason why I am so sensitive about the donor area and that it not be wasted. You are born with as many follicles as you are ever going to have so make each and every one count! I wish I had back the estimated 800 that were destroyed during my first surgery. No internet back then, unfortunately.

 

Best to you and your growth, Mick.

[Dr. Alan Feller]

I would like a definition of what "popular" means in the context of this thread. Also, if cost were the exact same, how many people would actually choose a strip procedure if they made the decision on their own accord (not sold on one procedure over another by an employee of a clinic)?

 

Or influenced and mislead by anonymous online posters.

[mav23100gunther]

You know, Mick, you hit on something in your post. You wrote:

 

"... in an ideal world maybe it shouldn't make any difference to one's self image or how people perceive us".

 

I find HT is rarely for others as much as it is for the person himself. I believe HT is really about "identity" and not so much "vanity". And I don't mean vanity in a bad way.

 

I have a friend who is as non-vane as you can get. He was already becoming a stage 5 hair loss sufferer but legitimately was not bothered by it. So when all my friends who needed transplants got them, he wouldn't even consider it. Until one day he came up to me and said he wanted one. I was truly floored. He had told other friends of ours that he wanted it and they were floored as well. What had changed? I had to ask.

 

He told me. And I quote: " I really didn't care about my hair loss until I looked in the mirror and saw my father staring back at me. I wasn't me anymore. "

 

I think that says it all and why the HT industry is huge. It is all about identity, not so much vanity. I feel the same way about myself. When I saw my forehead "growing" it wasn't "me" anymore. So I did something about it and that's how I got into the field.

 

Unfortunately, the doctor who did my first transplant did not do a good job and wasted some of my donor area I sorely need now. Perhaps that is one reason why I am so sensitive about the donor area and that it not be wasted. You are born with as many follicles as you are ever going to have so make each and every one count! I wish I had back the estimated 800 that were destroyed during my first surgery. No internet back then, unfortunately.

 

Best to you and your growth, Mick.

 

 

The only reason I got a HT, is so that women find me attractive again when I re-entered the dating scene after a break-up from a 5 year relationship. If we had stayed together and gotten married,, I would never have even considered it. Plain and simple - no other reason.

[Britanium]

Hi Dr Feller,

These posts have been very informative - i have enjoyed reading it through. Just wondered what were your thoughts on BHT ? does this also have lesser of a yield like FUE ??

[Yonex]

great thread this, Dr Feller, just to go slightly off topic for a moment, do many of your patients report sexual side effects from taking Finasteride?

[Mick50]

Bang on Dr Feller it' s not about vanity as such, I also reached the same point as your friend

it's about identity and confidence, confidence is a currency when it goes you're left bankrupt

[LondonHTseeker]

I saw Dr Wong today in London for a (very generous) free consult. When he saw how thin my donor hair is at the back he said; "Wooooah, they made it reaaallly thin." Luckily, I prefer it longer at the back now I'm older, so it's not noticeable. But for people who go on about it being easy to shave down after an FUE: it's often not that simple if you've had a lot of grafts removed. I just hope Dr Feller will agree to mFUE the surrounding donor hair, so that I can hit my thinning issues on top. And I'm getting on Propecia this week. After all that I hope to be set until some kind of new cure comes on the market.

[delancey]

I saw Dr Wong today in London for a (very generous) free consult. When he saw how thin my donor hair is at the back he said; "Wooooah, they made it reaaallly thin." Luckily, I prefer it longer at the back now I'm older, so it's not noticeable. But for people who go on about it being easy to shave down after an FUE: it's often not that simple if you've had a lot of grafts removed. I just hope Dr Feller will agree to mFUE the surrounding donor hair, so that I can hit my thinning issues on top. And I'm getting on Propecia this week. After all that I hope to be set until some kind of new cure comes on the market.

 

So what was the conclusion of the meeting with Dr. Wong? Did he suggest another FUT?

[LondonHTseeker]

He said I can probably only get about 1250 grafts via another strip operation, and to go for the free mFUE with Dr Feller (I intend to).

[delancey]

London, best of luck to you.

[mav23100gunther]

He said I can probably only get about 1250 grafts via another strip operation, and to go for the free mFUE with Dr Feller (I intend to).

 

London, isn't consulting with Dr Wong after Dr. Feller agreed to give you a free procedure akin to going on another 1st date after you agreed to be exclusive with your girlfriend?

[LondonHTseeker]

Maybe if I had secret intentions of being unfaithful, which I didn't; only went for advice. Edited June 21, 2015 by LondonHTseeker

[Garageland]

London, isn't consulting with Dr Wong after Dr. Feller agreed to give you a free procedure akin to going on another 1st date after you agreed to be exclusive with your girlfriend?

 

Lol, it's ok I knew of the free offer when London made the appointment so we knew it wouldn't be anything long term with us. Just trying to help to offer some advice.

[LondonHTseeker]

Many thanks for the free consultation, including the pictures and video of my donor hair and hairline, Garageland, it's very generous of Dr Wong and yourself! I've just sent them to Blake for his and Dr Feller's consideration.

[Sethticles]

I’m an Australian in Chiang Mai Thailand, probably the largest contingent of American expats and tourist here than anywhere else in Thailand. I have been living in Thailand for almost 7 years now, and in that time I have come across many Englishman, , but I have noticed especially here in Chiang Mai is being able to spot where other white guys are from. Very easy for me to spot and Aussie or Englishmen, clothes stance, body language and of course accents. Americans are just as easy to spot as well, most of you are very loud and say the word LIKE a lot, but also I have noticed that American men going bald tend to try and grow as much hair as they can, whereas Aussies and English tend to just shave it off and be done with it. Indian people also are a lot like the Americans in that aspect. So my observations have lead me to think that culturally there is differences in attitude to hair. Therefore the attitude to re growing your hair would differ from place to place. FUT by what I am gathering seems to more popular in America because they prefer to have some hair rather than shave down. FUE seems to more popular with Aussies and maybe the English because of the shave down no scar escape route. This forum has people from all parts of the world saying FUE is better or FUT is better, perhaps its where you’re from that is a part of your decision making.

[hairthere]

"FUT by what I am gathering seems to more popular in America because they prefer to have some hair rather than shave down."

 

I live in New York City and if I step outside I can literally see a minimum of 1 bald/shaved down guy per minute. It is an extremely popular styling choice here in the states. I think all men, regardless of nationality/religion/race, would prefer to not bald.

 

"This forum has people from all parts of the world saying FUE is better or FUT is better, perhaps its where you’re from that is a part of your decision making."

 

It's not about which surgery is better in general, it's about which surgery is better/makes more sense for YOU. This depends on several factors and does require some forward thinking and a realistic gameplan between patient and doctor.

[FUE2014]

If FUT is more popular in the States, it's probably more to do with the crippling high FUE costs over there.

[HairJo]

I never thought about hair loss and culture but it's an interesting concept thanks for sharing your point of view.