Regrowth percentage

[Dr Blake Bloxham]

Delancy,

 

Again, I'm not trying to be argumentative here; however, I don't think these quotes are being evaluated properly:

 

Dr Ron says 80% of the time, he believes the yields are on par with strip. So let's say this is 92% growth because Hairshopeing is saying my FUT averages are too high -- haha. This means 20% of the time, they are "visibly less." Visibly less means yields that result in densities below 40-45 FU/cm2. This means a growth of around 50%. So, again, let's do some math:

 

80% of the time * 92% yield = .8(92) = 73%

20% of the time * 50% yield = .2(50) = 10%

 

So let's add up the weighted averages: 73 + 10 = 83% overall average

 

And remember from before that yields in the 70s - 80s can result in FUG densities below the 40-45 FU/cm2 cut off that leads to a visibly thinner result.

 

So, again, we keep landing in the same range here. No matter how we try and play it, it keeps coming down to the same numbers when we really break it down.

 

So overall, yes I think the yields are in this range. And I really don't think people are refuting it much when you get right down to it.

 

And yes, research is key. But patients MUST have the facts. And hopefully this is helping.

 

Good post! Thanks for sharing.

Edited September 28, 2015 by DrBlakeBloxham

[delancey]

You are plugging and chugging and coming up with some numbers that support your argument. I can do the same thing:

 

80% of the time * 95 yield = 76 %

20% of the time * 75 yield = 15%

 

76% + 15% = 91%. All of a sudden we have a 91% weighted average FUE yield. We can easily bump this up by a few more percent by changing some of the inputs.

 

Let me ask you this. Have you spoken to any of the clinics that I mentioned above? Do they agree with your conclusion? I.e., that their clinics produce an average FUE yield of 80%?

 

Best,

 

D

[Melvin- Admin]

Delancy,

 

Again, I'm not trying to be argumentative here; however, I don't think these quotes are being evaluated properly:

 

Dr Ron says 80% of the time, he believes the yields are on par with strip. So let's say this is 92% growth because Hairshopeing is saying my FUT averages are too high -- haha. This means 20% of the time, they are "visibly less." Visibly less means yields that result in densities below 40-45 FU/cm2. This means a growth of around 50%. So, again, let's do some math:

 

80% of the time * 92% yield = .8(92) = 73%

20% of the time * 50% yield = .2(50) = 10%

 

So let's add up the weighted averages: 73 + 10 = 83% overall average

 

And remember from before that yields in the 70s - 80s can result in FUG densities below the 40-45 FU/cm2 cut off that leads to a visibly thinner result.

 

So, again, we keep landing in the same range here. No matter how we try and play it, it keeps coming down to the same numbers when we really break it down.

 

So overall, yes I think the yields are in this range. And I really don't think people are refuting it much when you get right down to it.

 

And yes, research is key. But patients MUST have the facts. And hopefully this is helping.

 

Good post! Thanks for sharing.

 

These numbers pulled out of thin air where did you get 50% growth 20% of the time? You're assuming visibly less means 50% I don't think Dr. Shapiro said that, so again Blake these numbers are based on your perception. Furthermore, from what you're saying based on "visibility" 83% is not visibly thinner than 95% because visibly thinner= 50% thanks for sharing.

[Dr Blake Bloxham]

Delancy,

 

I just wrote a huge reply and HTN froze and it didn't post. Wow.

 

I will try to recreate the points later if I have the time.

[Dr Blake Bloxham]

Alright Delancy, let me try this again ...

 

So the difference in the "plug and chug" -- reminds me of my high school math days! -- comes down to the definition of "visible thinning," the rule of averages, and what Dr Ron was describing in the first place.

 

First, visible thinning:

 

In order for the 76% yield value you plugged in to equate to a visibly thinner result, the average density would have to be about 60 FU/cm2 all over the entire scalp. It wouldn't be this high. In the hairline, maybe. But not all over the entire scalp. Let's say, for example, his average overall density was 55 FU/cm2. In order to get this down to 40 FU/cm2, you would need to have 72% at a maximum. At 76%, you would be at 42 FU/cm2 so you wouldn't technically hit the 40FU/cm2 cutoff. This means you'd need a lower growth yield in order to actually obtain a visibly thin result. So there was method to the values used in the equation.

 

However, a lot of this is "nitpicky" math, and I'll give that to you. BUT, it's much less important than the next points:

 

If we are sitting here being nitpicky with the math, remember that Dr Ron isn't. He is blatantly stating that he sees a visible difference in 20-50% (depending on which source you use) in the results. This doesn't mean we are dissecting out 76% versus 72% yield (which I will get into in a minute); this means we have one that grew like a strip and one that grew much less. And these are obviously in comparable patients. Otherwise the statement wouldn't make sense.

 

And this brings me to the averages here ... remember that in a Gaussian distribution, you have an average at the top of the curve and a whole tail of lesser numbers trailing off to one side. In order to get the average growth of an FUE procedure to the 80% that's been thrown around (and not just by me), you need to have a lot of lower growth yields to balance out the high growth yield Dr Ron says occurs 50-80% of the time (and sit on the other side of the curve). You can have visible thinning at an average of 75-80% like I discussed above, but it's more likely at these lower yields. And if Dr Ron can see this without analysis, it leads me to believe that he is seeing the low, lows to balance out the strip level yields which, again, is going to give us an average in the 75-80% growth range (50 + 95 / 2 = 73%). Here, you can start to see visible thinning, but the numbers have to just work out (which is why we could go back and forth with only slight variations in the plug and chug equation above). However, in order to really have the right off the bat obvious lesser growth, you need to have these low numbers (20-50% of patients per Dr Ron) to balance out the high (50-80% of patients per Dr Ron), and this is going to put our average right on this debatable cusp of 75-80% (50 + 95 / 2 = 73%).

 

As far as whether or not I've talked to other clinics: yes, I have. You'd be surprised. But just look at what Janna said if you need further confirmation. She's stating that she talked to the "top FUE" clinics and they said the same thing; 70-90%. Which averages out to 80%.

 

And, again, having this discussion is all just for the sake of those coming here to research. Patients should go into surgery informed with realistic expectations. This makes for happy members, which is what we all want in the end.

 

And thank you for participating. You are clearly a bright guy, and it's been a nice discussion!

[delancey]

According to a recent interview with IAHRS accepted member Dr. Ali Emre Karadeniz, "when an experienced FUE surgeon does FUE and takes care of all nuances, you may get and do get a close or equivalent result with strip surgery."

 

Note that Dr. Ali Emre Karadeniz is an IAHRS member who practices both FUE and FUT. In the interview, he speaks well about both procedures. Since the thread is about FUE yield, I will refrain from quoting other parts of the interview. However, it is a great interview. Private message me and I'll send you a link.

 

Edit: You may find the interview by googling the following keywords:

 

FUE Vs. FUT - Why FUE Alone Might Not Be The Perfect Solution

 

Dr. Blake, you seem like an ambitious man who is trying to help other people. I like that. However, there is a lot of information floating around and it must be very confusing for newbies coming on here for the very first time and getting exposed to all of the contrasting viewpoints and philosophies that exist. I happen to believe that FUE will grow to dominate the market in a few years.

 

Thanks for the discussion.

 

Best,

 

D

[Dr Blake Bloxham]

Hi Delancy,

 

Again, really look at what Dr K is saying here:

 

"when an experienced FUE surgeon does FUE and takes care of all nuances, you may get and do get a close or equivalent result with strip surgery."

 

"you may get close"

 

I don't think this is inaccurate. You very well may get close. And you also very well may not.

 

Here's something else he posted about an ISHRS presentation he did this year at the conference:

 

"FUE does not work on every patient and this may be evident only after doing an FUE test. Is it ethical to actually be an 'FUE-only clinic' [and] offer and do FUE on every patient?"

 

Seems like he's actually being pretty straightforward about it to me. I've actually always like most of what I've heard from him. And this is how it should be: clinics able to offer both and make appropriate recommendations to patients.

 

I agree that all the contrasting information is confusing. However, it's inevitable if we really want all the information out there. Allowing for only one viewpoint on a forum like this -- be it pro FUT or FUE -- is dangerous to the newbies you mentioned above. That's why we must have these discussions and really get all this out here.

 

Thanks again!

[Dr Blake Bloxham]

Delancy,

 

Just watched that interview; it's actually quite good. And Dr Karadeniz makes a few very similar points to what we've seen before: FUE megasessions are damaging to the donor region and complicate future procedures, it's most advantageous for patients to start with strip and then go FUE (he states that he likes this scenario because he's able to obtain a lot of grafts and a very good scar with one procedure and then finish off with FUE without overthinning the donor), and that single procedure clinics (FUT only or FUE only) are really missing a critical component by only offering one or the other.

 

And he does say you can obtain good yields with FUE when the characteristics are good. And I don't disagree with him either. But it's also clear, based upon the above quote I shared, that he doesn't think it's for everyone nor does it happen every time.

[delancey]

Please allow me to correct the quote below:

 

"when an experienced FUE surgeon does FUE and takes care of all nuances, you may get and do get, actually, a close or equivalent result with strip surgery.”

 

Dr. Karadeniz is unequivocally stating that when performed by an experienced FUE surgeon, FUE results are close or equivalent to strip results. Watch the video and you will clearly notice that he corrects himself. Again, without a doubt, he is clearly stating that FUE results are close or equivalent with strip surgery. Close or equivalent does not mean 80%.

 

Secondly, in case the first point raises any doubt, he states the following at the very end of the interview,

 

“FUE only clinics will emphasize that they can get the equivalent result in one session with more or less the same yield. They emphasize this so that you forget about this very important concept of lifetime hair potential. It is a deception. Because the strip surgeons fall into it as the opponents. They say no, our yield is better. And then the FUE surgeons come in and show excellent yield, and then the strip surgeons are busted.”

 

Again, FUE results speak for themselves, and I strongly agree with Dr. Karadeniz about FUE surgeons demonstrating excellent yield, in both surgeon and patient provided videos and pictures, on a consistent basis, on the many international forums. I feel that this is why your argument of 80% FUE yield is getting a lot of resistance.

 

Dr. Karadeniz comes across as a well-rounded surgeon, who provides both FUE and FUT to his patients, which makes his argument all the more interesting, in my opinion. In regards to your point concerning the order of procedures, has any reputable Doctor ever recommended that a patient get FUE before strip? If the strategy is to maximize available donor, it seems only logical to start with strip and then finish off with FUE. However, many patients do not need 8,000-10,000 follicular units. Yes, some do, but most patients fall in between.

 

In reference to your comment about FUE mega sessions, I couldn’t agree more. I believe in a slow and steady approach, and feel that it is very risky to put all of your eggs in the same basket by having a 4000 FUE mega session over two days. This is not to say that surgeons, such as Dr. Lorenzo, haven’t clearly demonstrated that we can pull 6000 FUE grafts over 2-4 procedures, without this affecting the result. This has been done, over and over again. I believe Dr. Ron Shapiro discusses this in one of his most recent interviews. The next challenge will be to extract above the 6,000 fu mark on a consistent basis when donor characteristics permit (over several procedures). I am also not convinced that FUT mega sessions of 6-8,000 grafts is a good thing. From my understanding, lower yield seems to be more related with dense packing than with the number of grafts transplanted. However, my research has indicated that it’s better to go with a slow and safe approach. What is your clinic’s opinion on this? Do you set an upper limit for how many grafts can be taken in one surgery? And if so, why?

 

Do I find it unethical that clinics do not offer both FUE and strip? No, I don’t. A Cost Accountant doesn’t work as a Financial Accountant. So why should an FUE surgeon have to perform FUT in order to be ethical? A patient is free to go to a Doctor who provides both. Truth be told, many clinics nowadays offer both. However, I do also believe that the strong shift in demand for FUE is driving a lot of strip outfits to offer FUE. At the end of the day, if a company has a strong demand for its service, it should continue to offer what it does best. That is what I would pay top dollar for. The marketplace will eventually create change and make businesses adapt.

 

Finally, it is also important to point out that there is always a risk with any form of cosmetic surgery, whether it be via FUE or FUT. Poor yield occurs with both methods. There are very reputable doctors who believe that FUE yield is getting very close, or already is equivalent to strip yield. Patients shouldn’t automatically assume that a strip procedure will automatically give a great result.

 

On a side note, I am always confused when Doctors use the term “pencil thin scar” because I am unsure whether they are referencing the thin or thick part of the pencil. Many scars seem to be around 3 mm, and perhaps thicker in other areas. I have above average donor density, and I feel that guard 3 would not be able to cover a 3 mm scar. This is something to think about, especially for men who prefer shorter hair styles. Many men like their hair long, so then it is not a concern.

 

Thanks for the discussion. This got a bit longer than I was expecting. lol

 

Best,

 

D

Edited September 30, 2015 by delancey

[Dr Blake Bloxham]

Delancy,

 

I think we could go back and forth forever here, but I don't think it's fair to say a statement is "unequivocal" when he uses terms like "may" or "close to" in the same sentence.

 

His point with the yield is that it's less of an issue than lifetime graft potential. What he's saying is that FUE clinics are using yield as a detractor to get FUT clinics to argue that their yield is better and ignore the problem with lifetime potential grafts -- which he argues is the bigger issue. He says that FUE clinics draw FUT clinics into a debate about yield; the FUE clinics then post results with good yield; it takes the wind out of the FUT surgeon's sails; and the result is that the FUE clinics look like they know what they are talking about so when the real problem -- in his opinion -- is brought up by the strip clinics, they look like they've already been defeated so no one takes them seriously. It's just an example of either a classic "straw man" or ad hominem argument depending on how you want to look at it. And he confirms it in the quote:

 

“FUE only clinics will emphasize that they can get the equivalent result in one session with more or less the same yield. They emphasize this so that you forget about this very important concept of lifetime hair potential. It is a deception. Because the strip surgeons fall into it as the opponents. They say no, our yield is better. And then the FUE surgeons come in and show excellent yield, and then the strip surgeons are busted.”

 

And note how he doesn't say it's strip level yield. He just says it's "excellent." And, again, he uses vague language by calling it "more or less" the same yield. And he actually makes no comments about consistency.

 

And this is the biggest problem with FUE: consistency. Dr Ron himself brought this up earlier: depending on the source you use (the patient he spoke with versus the video we saw) 2-5 out of every 10 patients don't grow the same. Who will be the 20-50%? Why does it happen? Could we have predicted it? Would it have happened if the grafts weren't strained during extraction?

 

The reason the numbers are being contested is simply because it's not popular opinion and people don't want to hear it. But that's not my fault! Haha. I'll go against the grain here. I know what I'm saying is correct, and this has been confirmed by pretty much every source that has been listed in this thread if you really read through it. The fact that Dr K started off with FUE only and felt the need to add both to his practice speaks volumes to this point. And even he himself -- and the host -- state that it's not driven home enough (or heard enough) online.

 

And you absolutely bring up an important point: nothing in medicine or surgery is guaranteed. But there are ALWAYS ways to optimize your chances of success. If you goal is to move as much quality hair from the back to the front, I, and many, many others, believe there is one specific way to optimize this. Not saying it's the right thing for everyone, but it's the most effective way to really "get the job done."

 

And remember that medicine isn't a traditional merchant:consumer business model. Just because something is becoming more popular doesn't mean it's equally effective. This is a timeless tale in medicine. Ask a bariatric surgeon about gastric banding or a cosmetic breast surgeon about trans-umbilical saline breast implants. It's not a doctor's job to sell or make a patient believe they can select a procedure or treatment like a menu item. It's the doctor's job to evaluate and offer their expert opinion on the best possible treatment. Not always sexy and popular, but it's technically the job. Even in a cosmetic field.

 

"Pencil thin" refers to a line drawn by a standard pencil. Not any part of the pencil itself. It's like this:

 

 

And I'm not commenting on the scale there, but simply showing the line they are referring to. I would consider 3mm "stretched" in a guy with normal skin. I wouldn't consider this really normal either. Like you said, so much of this process comes down to physiology. However, it's a myth that stretching is completely unpredictable or that good surgical protocol plays no role. I feel like most guys fall into a "normal healer" category and the "3 guard" rule applies. Keep in mind that you can see FUE scars around the 2 guard level as well.

 

Seems like we've pretty much covered it here! Plenty of good info for those researching to dissect.

 

Again, you've really provided some excellent content here. Thanks for discussing this in a civil and educational manner. It's really going to help some guys out down the road. We need more of this on HTN!

[delancey]

Blake, it's been a pleasure. Have a nice evening.

 

I enjoy how you inserted the image of the pencil. I don't see a lot of those "pencil thin" scars. "Pencil thin scar" does have a nice ring to it, though. hehe

[Dr Blake Bloxham]

Delancey,

 

You too!

[Wwiizzkkiidd24]

thanks for high jacking my thread you 2 hehe I joke I joke.

 

it's nice to see a civilised discussion of here for once haha.

 

imo if all scares came out luke that(pencil thin) and doctors could garrantee that scare I'd go for strip every day of the week but that isn't the case or garrantee. being a nw5 I'm kinda in between getting 8k via strip or 6-7k grafts blvia fue whichI'm sure I'd be happy with and plus I'd like my hair short rather then long because I've got curly/wavey hair so it's a nightmare to style so I just shave the sides down to a 2 gourd and that simply might not be possible if my scare turns out like the horror ones I've seen floating about on the Internet. but if it was pencil then 1-2mm thick I'd jump straight it but that simply isn't the case.

[Dr Blake Bloxham]

Wwizz,

 

Sorry for the hijacking!! Haha.

 

Best of luck in your research and future surgery. I think this thread will be really helpful for guys researching down the road. Thanks for starting it!

[delancey]

Wwizz, you should start threads more often. You've got a knack for it. haha

[Wwiizzkkiidd24]

I knew my talents layered somewhere ha ha