FUT is more popular than FUE

[CaliHairGuy]

FUT is more popular than FUE for two reasons, price and amount of grafts you can safely harvest at once, however in my opinion FUE is the preferred surgery for young men for the simple fact that in the event the transplant fails you can still shave your head. FUT in the years to come will start to phase out, once FUE techniques improve, once more and more physicians learn FUE and perfect the technique there will be more competition, which will drive the prices down, simple supply and demand. I do believe that in about 20 years you will hardly see FUT being done, I do believe that transection will be on par with FUT in the future as instrumentation improves.

 

Well, we'll see if transaction rates come down for FUE. Right now, FUT is still superior.

 

The other thing you're not considering is the larger scar tissue area that FUE creates. Until that can be reduced, starting with FUT and then transitioning to FUE for higher Norwood scale patients (like me) is still the preferred way to go.

[Dr. Alan Feller]

FUT is more popular than FUE for two reasons, price and amount of grafts you can safely harvest at once, however in my opinion FUE is the preferred surgery for young men for the simple fact that in the event the transplant fails you can still shave your head. FUT in the years to come will start to phase out, once FUE techniques improve, once more and more physicians learn FUE and perfect the technique there will be more competition, which will drive the prices down, simple supply and demand. I do believe that in about 20 years you will hardly see FUT being done, I do believe that transection will be on par with FUT in the future as instrumentation improves.

 

I'm sorry but FUT is more popular for one singular reason: It works better than FUE.

 

It would be nice if there were a scar free and consequence free surgery out there that would allow people to have their cake and eat it too, but unfortunately that doesn't exist. And FUE, such as it is, does not fill the bill.

 

FUE has it's place, but not in large sessions and certainly not in young men who most likely will need every graft they can get in the future.

[RecedingTide]

I'm sorry but FUT is more popular for one singular reason: It works better than FUE.

 

It would be nice if there were a scar free and consequence free surgery out there that would allow people to have their cake and eat it too, but unfortunately that doesn't exist. And FUE, such as it is, does not fill the bill.

 

FUE has it's place, but not in large sessions and certainly not in young men who most likely will need every graft they can get in the future.

 

What do you consider a large FUE session these days?

 

Of course each method has it's advantages and disadvantages. With a top notch FUE clinic the amount of grafts that fail to grow due to the slightly reduced yield is in my opinion offset by the telogen grafts that end up in the bin with FUT. I still think you can get about 15% more grafts with FUT alone vs FUE alone lifetime, but in chasing those extra grafts you risk a wide scar.

 

If someone is Norwood 4 or more at the time of going for their first transplant it makes sense to go FUT just to get a satisfying result within a year. Norwood 3 or less have both options. That being said Lorenzo and Erdogan are two guys that seem to be able to make a big difference to Norwood 4s in just a single pass.

 

Dr. Feller, with the greatest of respect, you should still seriously consider taking on more FUE cases going forward. I say this as many people are informed of the slightly lower yield (especially with singles in the feather zone of the hairline) but they simply do not care as for many the scar really is a deal breaker.

 

Let's not forget the life changing result your provided for Spencer Stevenson with FUE.

[FUE2014]

Dr Feller your assertions about FUE would have more credibility if other FUT docs who also perform FUE came on here to support them, but I haven't seen this so far.

[Melvin- Admin]

I'm sorry but FUT is more popular for one singular reason: It works better than FUE.

 

It would be nice if there were a scar free and consequence free surgery out there that would allow people to have their cake and eat it too, but unfortunately that doesn't exist. And FUE, such as it is, does not fill the bill.

 

FUE has it's place, but not in large sessions and certainly not in young men who most likely will need every graft they can get in the future.

 

I humbly disagree Dr. Feller, FUT is popular because its cheap, I do agree that it works better in terms of yield because of less transection, but I think the key thing is it works better than FUE for now. How much has FUE advanced just within the last few years? I mean 10 years ago having mega sessions for FUE was unheard of, also I think that it should be stated that FUE is a better option for high norwood cases for the simple fact that you can harvest body hair as well, you don't only have to depend on donor hair, a norwood 7 is not a surgical candidate for FUT, however with FUE, the combination of donor hair and bodyhair has been shown to yield some good results.

 

I also agree and hate when people say FUE is a scarless procedure, there is no surgery with out a scar, however the cosmetic scars are much less than FUT, here is my scar shaved down with no guard or a zero, you can see some scarring but you'd have to really examine my scalp to notice, at a glance the scar is insignificant cosmetically. The scar on the left side I received from hitting my head when I was 7 years old stands out way more than the FUE scars as you can see.

 

I agree with a well known FUE practitioner who I cannot name here, he states that FUT is probably better for low norwood cases that could get a full restoration with one procedure, however if you are a high norwood case, its probably better to do FUE because you are going to need body hair if you want to get even close to a full restoration, norwood 6,7 simply do not have enough follicular units available. That's why high norwoods should be advised that in order to achieve a descent cosmetic result more than likely body hair will have to harvested to add additional density and coverage. There are rare cases that norwood 6 and 7 can achieve full restoration doing several FUT procedures, this is definitely not the norm, the majority of individuals are going to need FUE that includes body hair.

Edited August 3, 2015 by David - Moderator

[Melvin- Admin]

Dr Feller your assertions about FUE would have more credibility if other FUT docs who also perform FUE came on here to support them, but I haven't seen this so far.

I agree, I would also like to see some more patients who've had FUT and FUE get involved in the discussion.

[Dr. Alan Feller]

Perhaps the best way to begin is by presenting an article written by another FUT/FUE doctor that was published in our industry journal "The Hair Transplant Forum International" July/August 2014 written by Dr. Michael Beehner-who is also an HTN Coalition Member as well.

 

Dr. Beehner noticed the same issues with FUE independent of me and felt compelled to write the following last year. I have not read of a single doctor who disagreed with a single word he wrote, in fact just the opposite:

 

I took photos of the article. See below:

 

 

Edited August 3, 2015 by Dr. Alan Feller

[win200]

Fascinating article from Dr. Beehner. I was 29 when I got a strip surgery in 2012, and a NW1.5-2. I was the archetypal guy who's told that FUE is the way to go, but I could not be happier that I opted for FUT. I got a dense transplant with that appears to be a very high graft survival rate, I know I have more strips, if necessary, in the tank, and I also know that if my scar bothers me, I can have some FUE into it for camouflage. I think too many folks overlook that possibility.

 

And here's the thing about scars: they're really not so bad. I have a so-so scar and I have no problem covering it up. Like most young gay guys these days, I wear my hair very short on the sides; a 2.5 guard most of the time. At that length, the scar does show a bit, but I smear some DermMatch on it and it's pretty undetectable. Most people grossly overestimate the amount of attention people pay to the back of their heads, and no one is going to notice your scar unless you buzz down VERY short. Also, most people have no idea what a hair transplant scar is, so they won't know why it's there even if they do spot it. I'd say at a 3 guard, nearly all scars will be invisible.

 

I really appreciate Dr. Feller's attention to this issue, and I think more guys (especially the younger ones) that are pushed hard toward FUE need to think good and hard about the choice. It's a significant one that you'll live with for the rest of your life.

Edited August 3, 2015 by David - Moderator

[Dr. Alan Feller]

This snippet in particular has come true and stands out:

[spitfire uk]

I agree, I would also like to see some more patients who've had FUT and FUE get involved in the discussion.

I've had both , I'm 35 now and back in 2008 i had quite a lot of loss in my crown....ironically i went to Dr Feller and had strip of 1800 grafts which gave me good enough coverage for then and i was pleased enough. Last year i decided to see if i could finish the crown or a least get more density , i decided to look into FUE as while I'm happy enough with the scar i have from 2008 i didn't want another and more importantly i didn't think my current loss justified another strip so i went to Dr Doganay for 1057 FUE.

I honestly think both have there parts to play in the H/T world but both come at a cost , while i do believe strip gives slightly more established results i understand scars are a big thing for people....I've lost count the amount of times I've sat twitching in Hairdressers thinking they are staring at the back of my head in fact I'm on about my 8th different barber!

FUE on the other hand has grown hugely in the last 10 years , i found it a lot less painful than my first op and seemed quicker too. I'm still only 9 months out on FUE so it's hard for me to fully judge yet. I personally don't believe in big FUE sessions , I'm not keen on grafts being out for long spells either.....for me anything over 4000 grafts is risky but at the end of the day any sort of H/T carries a risk and that's without going into each Dr's result / your genetics etc.

Overall i think there's not much between them , strip just about edges consistency (i may change my mind when my fue is grown out) but that does come of the cost of having a strip for life no matter how good the scar is (and mine from Dr Feller is good ).

Just my views guys .

[Dr. Alan Feller]

Thank you for the kind words Spitfire.

Grow well!!!

[mav23100gunther]

also I think that it should be stated that FUE is a better option for high norwood cases for the simple fact that you can harvest body hair as well, you don't only have to depend on donor hair, a norwood 7 is not a surgical candidate for FUT, however with FUE, the combination of donor hair and bodyhair has been shown to yield some good results.

 

.

 

 

Hi HTsoon

 

If FUT gets you a greater number of lifetime donar grafts over FUE, then surely FUT combined with FUE once stripped out, and then BH once donor supply is all gone is the best option for norwood 7? why would getting FUT strip rule out BHT????

[Melvin- Admin]

Hi HTsoon

 

If FUT gets you a greater number of lifetime donar grafts over FUE, then surely FUT combined with FUE once stripped out, and then BH once donor supply is all gone is the best option for norwood 7? why would getting FUT strip rule out BHT????

 

I'm not saying you cant do both, i'm simply comparing both method side by side, i'm not pro FUE or anti-FUT, because both methods have their place in today's hair restoration. It's my opinion that FUE is the future of hair restoration but that doesn't mean you can't get both procedures, it all boils down to what you (the patient) want to accomplish, I don't particularly like when FUT or FUE physicians constantly bash one another, because there are good things about both, and not every person is going to be a good fit for either procedure, in my opinion when physicians do this it takes away credibility of their work.

 

When FUE physicians say that FUT will create horrible scars and FUE is scarless thats simply not true, but at the same time, when FUT physicians say FUE does not have good yields and its a waste of grafts, this is also not true, there are several FUE physicians that have yields comparable to any top FUT physician. When people say FUT has better yields over FUE we're talking about averages, not all surgeries are created equal, there was even a documented case of an individual on this board who had FUT to the crown by one of the worlds best FUT surgeons and the yield was poor.

 

So I guess what i'm trying to say is everyone should research each procedure weight the pro's and con's of each procedure and choose what best fits them. Also, take whatever a physician who specializes in a particular procedure says with a grain of salt, it's better to listen from patient's as there are no monetary gains or incentives.

Edited August 4, 2015 by Melvin-HTsoon
misspelling

[mav23100gunther]

I'm not saying you cant do both, i'm simply comparing both method side by side, i'm not pro FUE or anti-FUT, because both methods have their place in today's hair restoration. It's my opinion that FUE is the future of hair restoration but that doesn't mean you can't get both procedures, it all boils down to what you (the patient) want to accomplish, I don't particularly like when FUT or FUE physicians constantly bash one another, because there are good things about both, and not every person is going to be a good fit for either procedure, in my opinion when physicians do this it takes away credibility of their work.

 

When FUE physicians say that FUT will create horrible scars and FUE is scarless thats simply not true, but at the same time, when FUT physicians say FUE does not have good yields and its a waste of grafts, this is also not true, there are several FUE physicians that have yields comparable to any top FUT physician. When people say FUT has better yields over FUE we're talking about averages, not all surgeries are created equal, there was even a documented case of an individual on this board who had FUT to the crown by one of the worlds best FUT surgeons and the yield was poor.

 

So I guess what i'm trying to say is everyone should research each procedure weight the pro's and con's of each procedure and choose what best fits them. Also, take whatever a physician who specializes in a particular procedure says with a grain of salt, it's better to listen from patient's as their are no monetary gains or incentives.

 

Some very good points, and I'm well aware of the H&W patient who appears to have had low yield from a crown procedure, although I'm sure H&W would argue differently. That's 1 case though, but I highly doubt he would have had greater success if he had went with FUE. However, your previous statement "

also I think that it should be stated that FUE is a better option for high norwood cases for the simple fact that you can harvest body hair as well, you don't only have to depend on donor hair, a norwood 7 is not a surgical candidate for FUT, however with FUE, the combination of donor hair and bodyhair has been shown to yield some good results."

simply isn't true. If FUT can get you more lifetime grafts, which a FUE surgeon has yet to dispute, then mathematics tells you that surely FUT until being stripped out, then switching to FUE and finally BHT is the best option for higher norwoods over going with FUE and BHT is it not? So far the only pro of FUE over FUT is the lack of the linear scar. I appreciate you are providing an opinion mate, but the facts are suggesting otherwise. I have yet to hear a FUE surgeon claim that FUE provides greater lifetime grafts over FUE or lower transaction over FUE.

[Sethticles]

I've lost count the amount of times I've sat twitching in Hairdressers thinking they are staring at the back of my head in fact I'm on about my 8th different barber!

 

interesting point, which hardly ever gets raised here, self confidence, social awareness, prying eyes, hiding a big secret, this for most is the massive difference between FUE / FUT, Spitfire looking back to 2008 and knowing what you know now would you choose FUT over FUE.

[Dr Blake Bloxham]

Seth,

 

When I do a consultation, either online or in person, I generally see two very broad categories of patients:

 

Category 1: This is about 98% of patients I see. These are guys who say: "I've been bald or thinning for X number of years. I'm going through Y in my life right now, and finally have the opportunity to fix this. Please put as much reliable hair in the front as possible." These guys get it. They understand what we are trying to do with a hair transplant procedure. They also understand that surgery is just that: surgery. Any time a scalpel, needle, or punch touches your skin, it leaves a scar. If we do our job right, the trade off is a cosmetically acceptable scar buried under good donor hair and nearly 100% growth of healthy hair in the front. These guys are focused on the actual hair in the front and want the most "bang for their buck."

 

Category 2: The other small minority of patients. These are the patients who mention the donor scar within the first few lines or few minutes of a consultation. These gentleman, unfortunately, often fall prey to a "self fulfilling prophecy." They want the "back up" option to shave their head. So they opt for a procedure that's crippled from the starting line that all but ensures they won't be happy with the results and will, indeed, shave their heads at some point. I usually tell these patients the following: "if you're really considering this option, try shaving your head now. You may like it, and it will save you the hassle of having any surgical procedure. It will also actually allow you to shave down without the risk of any scarring, because your barber will see the punctuate FUE scars if you chose to shave down low enough as well."

 

But the bottom line is that no one sees, is thinking about, or cares about any sort of scar on your scalp. 99.9% of the world, including barbers, has no idea what a hair transplant scar looks like. No "prying eyes." UNLESS you do opt to undergo a procedure that could leave poor growth and wiry/kinky hairs in the front of the scalp. Now this people may actually notice.

[Melvin- Admin]

 

Category 2: The other small minority of patients. These are the patients who mention the donor scar within the first few lines or few minutes of a consultation. These gentleman, unfortunately, often fall prey to a "self fulfilling prophecy." They want the "back up" option to shave their head. So they opt for a procedure that's crippled from the starting line that all but ensures they won't be happy with the results and will,

But the bottom line is that no one sees, is thinking about, or cares about any sort of scar on your scalp. 99.9% of the world, including barbers, has no idea what a hair transplant scar looks like. No "prying eyes." UNLESS you do opt to undergo a procedure that could leave poor growth and wiry/kinky hairs in the front of the scalp. Now this people may actually notice.

 

I'm sorry but this is just flat out false, FUE is not crippled from the starting line, again Dr. Bloxham not every patient is right for FUT, FUE done correctly has a fantastic yield comparable to FUT.

 

Here is a picture of my before and after taken in the same bathroom same lighting, 1,800 grafts

I challenge any FUT procedure of only 1,800 grafts to look any better at my level of baldness I must add i'm very happy with the result.

 

Myth #2 no one sees the scar or looks at it, this is simply not true, my friend had FUT back in 2006 with a well known clinic in Toronto, literally every single barber he's ever gone too has asked him about the scar, they ask if it was brain surgery, did he have a seizure, if he has a metal plate in his head, im not kidding either, friends that we hadn't seen in high school literally would walk up to him and be like "wooowww dude what happened to your head" ever since then he's kept his hair very long on the side, you have to accept the fact that some individuals just don't want to grow their hair long on the sides, I have never kept my hair longer than a #2 on the sides ever, with FUE I can wear it down to a one or zero and the scars are barely visible.

 

Dr. Bloxham I know you are starting out as a physician and you want to grow your practice, but I think it would be better to allow patients to make up their own minds about what procedure fits them the best, just because a patient does not choose FUT does not mean that they can not achieve good results this is just not true. Also, just to add that hair styles change all the time, there may come a time when a patient wants to wear their hair short on the sides, FUE gives the patient more freedom, to someone like myself a linear scar is not the best choice.

 

Here are some examples of high norwood patients class 5 or 6 hair loss pattern, the results were absolutely great. How can you say these patients wont be happy with these results?

 

 

list=PLOSBsLm4QYXGTLwzKtB4ONQ1RaHzBfTQJ

http://www.hairrestorationnetwork.com/eve/168673-3530-850%3D4380-grafts-dr-hakan-doganay.html

3,100 grafts :eek: seriously yields absolutely on par with FUT with certain surgeons.

http://www.hairrestorationnetwork.com/eve/169919-3100-grafts-dr-hakan-doganay.html

[monaba]

UNLESS you do opt to undergo a procedure that could leave poor growth and wiry/kinky hairs in the front of the scalp. Now this people may actually notice.

 

Hi Dr, I have a question. I had a HT in at a mediocre clinic and had very poor results (surprise, surprise). I'm having a repair surgery in couple of weeks with an excellent, recommended Dr. Anyways, I had very poor results from my first HT, and the transplanted hair looks very different than my native hair. It is very wiry/kinky as you mentioned. My question is, why does this happen? What factors cause the transplanted hair to look very different than the native hair (i.e. what factors cause the kinkiness)? My transplanted hair is not even combable.

 

Is there a way to reach out to you for consultation? I'm just curious to hear your opinion about my case and my intended repair plan.

 

Thanks!

[Sethticles]

But the bottom line is that no one sees, is thinking about, or cares about any sort of scar on your scalp. 99.9% of the world, including barbers, has no idea what a hair transplant scar looks like. No "prying eyes.".

 

we are not talking about the rest of the world, we are talking about the patient and the patient's feeling, this was the discussion, the guy said he's been to 8 different barbers since 2008, he clearly is worried about what the barber is thinking and what the other customer's prying eyes are looking at while waiting their turn in the shop, pretty sure this is a common gut feeling of alot FUT patient's, there is no doubt there is a massive stigma attached to FUT and the 25cm scarring and the fact all will do anything to keep it a secret,

 

probably why alot of us FUE patience are so positive because of such Barber type situations that we have all experienced during the years of losing our hair and going to the barber, I can speak from experience that feeling your get when all eyes are starring at your bald patch, why on earth you would try and fix the problem with creating yet another problem, the self conscience cycle continues with FUT and problem for life.

 

Blake perhaps try and stay on topic if you want to direct a reply to me in the future thanks mate

[Dr Blake Bloxham]

HT,

 

First, I'm very pleased you were able to find a procedure that fit your needs.

 

However, you say we need to let patients make up their minds. I ask, how do they do this? They need to be given the facts. Plain and simple. If we don't have these very important conversations -- which you're a part of, patients won't be able to make the right decisions. Like I've said before, telling the truth isn't always popular or sexy. But it needs to be out there.

 

Having said that, let me address your points:

 

1) Your challenge is to find a roughly 1,800 graft strip case on a diffuse NW 4a to 5 patient that rivals your results. I timed myself. I spent 1 minute and 30 seconds reviewing the "results posted by physicians" category of the site and came up with the following:

 

Patient with a similar pattern; 2,000 grafts (very close to yours); done via strip:

 

 

 

 

 

All credit goes to the very talented Dr Scott Alexander for that one.

 

2) Your point about people noticing your friend's scar. Here's the problem with this answer. You say you have 1 friend who had strip and now has an issue with the scar. Your "sample size" is 1. I had a patient in today who had 2 previous strip procedures with a chain clinic, scarred poorly, still cuts his hair the exact same way he always has, and has never had one issue, comment, or problem with the scar. He's not happy with the growth in the front, but has never even thought about the scar. Now my sample size is 1 as well, and our arguments have the same validity. What if I told you that I see that same patient in the OR and consultation room 10 times a week? See why my opinion of the gravity of the scar may be a bit different?

 

3) Your donor. Yes, your scars -- though still visible -- are cosmetically acceptable on the surface. But imagine taking all those little dots you see on the surface, multiplying it by two, and pushing this network of scar under your skin. This is what your scalp is like now post-FUE. What would happen if your results didn't grow as planned? Now we have to go in and try to steal another 1,800. But now the grafts are ripping, transection is increasing because we aren't getting the right tissue feedback, and you're absolutely not going to get another 1,800 growing.

 

4) Which brings me to this point: the "crippled argument." I stand by this. FUE cripples your race horse right out of the gate. No two ways about it. The grafts are twisted, ripped, crushed, skeletonized and grow around 20% less than the same grafts taken out by strip. If you have a horse with 4 legs, and I tie one of them off and make him run on 75% capacity before the gates even open, what do you call this? Crippled before the race even starts. Again, I'm not going to win any friends here. But it's the truth. And I'm okay with that.

 

5) I'd actually have a lot less headaches and more money if my practice was all FUE. But it's not the right way to do things. And you're right, there is a time and a place for strip and FUE. But I don't think FUE's place is ever for sessions this big.

 

Here's my philosophy: If you need some small patchwork, some refinement somewhere (and BTW, I really don't like using FUE for hairline refinement because I don't think the quality of the hair growth is suitable for the most visible region of the scalp), sure, FUE is fine. If you need a lot of grafts that will actually grow and may need procedures down the road. FUT is your man. Spoiler alert: you will have a scar. Unfortunately, I don't have a magic wand. I'd love to give guys Brad Pitt's hair with no signs I ever touched their scalp daily, but my dark arts magic isn't at that level yet ; ).

 

HOWEVER, you bring up a very valid point: some guys just absolutely can't live with the strip scar. And I get it. I'm not here to bully these guys into a procedure that will leave them unhappy. So here's what I tell them: the only reason to do an FUE over a strip is the linear scar. Otherwise, strip pummels FUE without question. Better growth, better quality, and virgin donor left for more procedures. So, this should be your go to. If you cannot deal with the scar, do the procedure as a modified FUE (mFUE). This way, you won't have the scar, BUT we have grafts we can rely on AND the donor is less wrecked. For those who really want to "have their cake and eat it too," this is THE option.

 

6) Those FUE results. Yes, those results look good. And I'd never stand here and say you cannot get a good result with FUE, because that's not true. We've all seen examples of it. However, the problem is that for every 10 ANY doctor -- let me say that again: ANY doctor -- does, you'll get 1-2 that are great, 5-6 that are okay, and 1-2 that just flat out don't work. This is why FUE patients are screened and selected carefully. Now, back to those results: they look good, but they would have looked fuller and thicker as a strip. And I'll go tit-for-tat with you on FUE versus strip home run cases all day long. For every 1 FUE "wow" result you find, I'll show you 5 "wow" strip results.

 

I hope this is taken in the spirit in which I intended. Like I said before, the things I'm saying aren't hip, fun, sexy, or exciting. But neither is science or medicine/surgery. And as a doctor, I feel the need to say these things. Patients need all the facts available to them before making a decision. And I think we can all respect that.

 

Thank you for participating in this discussion. Hopefully you find it as fascinating as I do. And believe it or not, we really are helping some guys make the right decision here. Keep it up!

[Dr Blake Bloxham]

Monaba,

 

Sorry to hear this, man! Glad you found a doctor to help you out. Keep us updated on your progress.

 

I'm always here to answer questions. I don't care if they are about surgery, hair loss in general, FUE, FUT, et cetera. I just like helping you guys out! Send me a private message here or feel free to email me.

 

Now, back to your question:

 

This is actually a phenomenon I feel is very under reported. Did you have an FUE or strip procedure? It occurs in FUE versus FUE/FUT for two different reasons:

 

The characteristics of the hair shaft is determined by the internal portion of the follicle. Kinky, wavy, straight, thick, and fine, this is determined by inner portion of the follicle right above the "hair bulb." If this part of the follicle becomes distorted, it produces hairs that are distorted as well. Hairs grow "kinky" and "wiry" for the first 9(ish) months after hair transplant surgery because the inner portion of the follicle is still re-orienting and correcting itself after being transplanted. When it does re-orient itself back to the normal position, it begins producing normal hairs.

 

However, I believe the excessive forces put on grafts during FUE procedures can cause permanent damage to the inner portion of the follicle. When this occurs, the inner portion of the follicle is never able to orient itself correctly and it creates kinky, wiry hairs indefinitely. Doesn't happen every time, but it can -- and does -- happen.

 

Now, there is another way this can occur in both strip and FUE surgery. If for any reason the grafts are crushed during placement or placed into incision slits that are too small, a similar phenomenon occurs and you see the kinky, wiry hairs.

 

The difference is that when this occurs during implantation, it was a surgical error. But, it can occur in FUE even when everything is done correctly.

[Melvin- Admin]

HT,

 

First, I'm very pleased you were able to find a procedure that fit your needs.

 

However, you say we need to let patients make up their minds. I ask, how do they do this? They need to be given the facts. Plain and simple. If we don't have these very important conversations -- which you're a part of, patients won't be able to make the right decisions. Like I've said before, telling the truth isn't always popular or sexy. But it needs to be out there.

 

Having said that, let me address your points:

 

1) Your challenge is to find a roughly 1,800 graft strip case on a diffuse NW 4a to 5 patient that rivals your results. I timed myself. I spent 1 minute and 30 seconds reviewing the "results posted by physicians" category of the site and came up with the following:

 

Patient with a similar pattern; 2,000 grafts (very close to yours); done via strip:

 

 

 

 

 

All credit goes to the very talented Dr Scott Alexander for that one.

 

2) Your point about people noticing your friend's scar. Here's the problem with this answer. You say you have 1 friend who had strip and now has an issue with the scar. Your "sample size" is 1. I had a patient in today who had 2 previous strip procedures with a chain clinic, scarred poorly, still cuts his hair the exact same way he always has, and has never had one issue, comment, or problem with the scar. He's not happy with the growth in the front, but has never even thought about the scar. Now my sample size is 1 as well, and our arguments have the same validity. What if I told you that I see that same patient in the OR and consultation room 10 times a week? See why my opinion of the gravity of the scar may be a bit different?

 

3) Your donor. Yes, your scars -- though still visible -- are cosmetically acceptable on the surface. But imagine taking all those little dots you see on the surface, multiplying it by two, and pushing this network of scar under your skin. This is what your scalp is like now post-FUE. What would happen if your results didn't grow as planned? Now we have to go in and try to steal another 1,800. But now the grafts are ripping, transection is increasing because we aren't getting the right tissue feedback, and you're absolutely not going to get another 1,800 growing.

 

4) Which brings me to this point: the "crippled argument." I stand by this. FUE cripples your race horse right out of the gate. No two ways about it. The grafts are twisted, ripped, crushed, skeletonized and grow around 20% less than the same grafts taken out by strip. If you have a horse with 4 legs, and I tie one of them off and make him run on 75% capacity before the gates even open, what do you call this? Crippled before the race even starts. Again, I'm not going to win any friends here. But it's the truth. And I'm okay with that.

 

5) I'd actually have a lot less headaches and more money if my practice was all FUE. But it's not the right way to do things. And you're right, there is a time and a place for strip and FUE. But I don't think FUE's place is ever for sessions this big.

 

Here's my philosophy: If you need some small patchwork, some refinement somewhere (and BTW, I really don't like using FUE for hairline refinement because I don't think the quality of the hair growth is suitable for the most visible region of the scalp), sure, FUE is fine. If you need a lot of grafts that will actually grow and may need procedures down the road. FUT is your man. Spoiler alert: you will have a scar. Unfortunately, I don't have a magic wand. I'd love to give guys Brad Pitt's hair with no signs I ever touched their scalp daily, but my dark arts magic isn't at that level yet ; ).

 

HOWEVER, you bring up a very valid point: some guys just absolutely can't live with the strip scar. And I get it. I'm not here to bully these guys into a procedure that will leave them unhappy. So here's what I tell them: the only reason to do an FUE over a strip is the linear scar. Otherwise, strip pummels FUE without question. Better growth, better quality, and virgin donor left for more procedures. So, this should be your go to. If you cannot deal with the scar, do the procedure as a modified FUE (mFUE). This way, you won't have the scar, BUT we have grafts we can rely on AND the donor is less wrecked. For those who really want to "have their cake and eat it too," this is THE option.

 

6) Those FUE results. Yes, those results look good. And I'd never stand here and say you cannot get a good result with FUE, because that's not true. We've all seen examples of it. However, the problem is that for every 10 ANY doctor -- let me say that again: ANY doctor -- does, you'll get 1-2 that are great, 5-6 that are okay, and 1-2 that just flat out don't work. This is why FUE patients are screened and selected carefully. Now, back to those results: they look good, but they would have looked fuller and thicker as a strip. And I'll go tit-for-tat with you on FUE versus strip home run cases all day long. For every 1 FUE "wow" result you find, I'll show you 5 "wow" strip results.

 

I hope this is taken in the spirit in which I intended. Like I said before, the things I'm saying aren't hip, fun, sexy, or exciting. But neither is science or medicine/surgery. And as a doctor, I feel the need to say these things. Patients need all the facts available to them before making a decision. And I think we can all respect that.

 

Thank you for participating in this discussion. Hopefully you find it as fascinating as I do. And believe it or not, we really are helping some guys make the right decision here. Keep it up!

 

I'm not a Norwood 4 the example you presented is no where near the level of baldness I posses

You are not giving any facts, you're giving opinions, for every 5 FUT result you get 1 good FUE that's opinion, also good results are entirely up to the patient i might add. I must say doc to the more and more you push your pro FUT the more and more you alienate potential candidates, I'm always weary of someone preaching one way as gospel be it FUE or FUT. Patients need to do their own research, I would never got to a surgeon and take what ever he/she says as 100% truth because there are monetary incentives involved, the fact that you say you'd be hassle free if you did FUE is also false, FUE is time consuming and far more tedious than FUT. The learning curve takes long, you're starting out so I don't blame you going for FUT, but the FUE bashing is unnecessary and honestly it detracts from your work in my opinion, if FUT is so great let your work speak for itself? allow patients to research things themselves, it's not a one size fits all.

[Dr Blake Bloxham]

HT,

 

I agree. Give the patients the facts and encourage them to do their research! Right on.

[monaba]

Hi Dr. Blake, Thanks a lot for your swift and thorough response. I actually had a FUT? Is this phenomenon common in FUT as well? It is very noticeable that the transplanted hair is very different than my native. I will contact you to discuss it more. Thanks again for the great support! I have my surgery soon with Dr. Koray. I will keep you updated.

[Dr Blake Bloxham]

Mon,

 

It can happen with both. But really only in FUT if the grafts weren't handled or placed correctly. In my opinion, it's much more common in FUE for the reasons I outlined above.

 

Best of luck!