Discussing Highlights from the 2015 ISHRS Scientific Meeting in Chicago

[TakingThePlunge]

Each year the International Society of Hair Restoration Surgery (ISHRS) holds its annual scientific meeting to discuss hair loss and advancements in medical and surgical hair restoration. This year, the ISHRS meeting was held in Chicago.

 

As always, we interviewed a number of recommended physicians in order to provide our members with their input on the meeting. These highlights have been presented on our popular Hair Loss Q&A Blog.

 

As you might expect, FUE was a hot topic again this year. A number of FUE related topics were discussed including; body hair transplantation, a comparison of strip vs. FUE yield and the advantage of pre-making FUE recipient incisions before harvesting among others.

 

To learn what's new in hair restoration from expert hair transplant surgeons, see:

 

Highlights from the 2015 ISHRS (International Society of Hair Restoration Surgery) Scientific Meeting in Chicago

 

Physicians directly contributing to this article are:

 

Dr. Mike Beehner

Dr. Robert Bernstein

Dr. Tejinder Bhatti

Dr. Jean Devroye

Dr. Robert Haber

Dr. Bill Parsley

Dr. Damkerng Pathomvanich

Dr. Sanusi Umar

Dr. James Vogel

 

We hope you enjoy reading about these interesting developments.

 

All the best,

 

Pat, Bill and Dave

[ZeoRanger]

That FUE/FUT comparison case study is quite a shocker...

[hairlosscpa]

That FUE/FUT comparison case study is quite a shocker...

 

I agree. The FUE results make me sad, especially being 2 months out from my procedure.

[Bill - Seemiller]

Dave,

 

Thanks for creating a forum topic so that members can discuss this year's 2015 ISHRS Scientific Meeting and its presentations.

 

I too found the findings on the FUT versus strip study quite interesting. That said, it's only one study in one physician's hands with a certain set of tools. Thus, I don't think any real conclusions can be drawn from this about FUE in general however, I don't think we should discount the evidence from the study.

 

It's been my long time belief (based on many factors) that FUE as a donor harvesting method is far less consistent, mostly because grafts are blindly dissected whereas with strip, trained technicians can see everything they are doing under microscopic dissection. That said, many surgeons/clinics have been able to use their sense of touch or "feel" to harvest follicular units via FUE quite successfully without damaging them and ultimately produce outstanding results on par with strip. Thus, while as a whole I believe strip is more consistent, I know that FUE is a viable procedure, especially when used in conjunction with strip to maximize the amount of hair moved from the donor to the balding areas.

 

Best wishes,

 

Bill

[esrec]

Really interesting, thanks for sharing.

 

Do you think that the quality of the graft (That visual provided of the protective skin around the FUT graft in comparison to FUE) Is something that can be mitigated with technique or skill or simply a reality that will always exist regardless of tool or extraction method?

 

Also interesting (and simplistic) position of Dr. B on simply reversing the order. Imagine if its really that obvious.

[mav23100gunther]

That FUE/FUT comparison case study is quite a shocker...

 

Feller must be sharpening his knives right about now.

[MrMatt]

Summary:

 

Based on this study of 1780 FU grafts in 4 patients, a projection can be made that:

 

11% of all FUT grafts will fail

43% of all FUE grafts will fail

 

I will gladly accept these numbers as true when pigs fly.

[harin]

Also perhaps everyonehas noticed this difference.:

 

In all four patients the lower half of the FUE grafts were mostly stripped of fatty tissue and the bulbs were mostly “naked” without protective tissue.

 

Many physicians as Dr. Bernstein indicated have started gotten away with stripping the fatty tissue, I think in hands good at performing FUE the results will likely be different.

[JON86]

Very interesting points made by Dr. Bernstein. Pre making recipient sites is an interesting concept and could change the face of fue.

[FUE2014]

Dave,

 

I too found the findings on the FUT versus strip study quite interesting. That said, it's only one study in one physician's hands with a certain set of tools. Thus, I don't think any real conclusions can be drawn from this about FUE in general however, I don't think we should discount the evidence from the study.

 

It's been my long time belief (based on many factors) that FUE as a donor harvesting method is far less consistent, mostly because grafts are blindly dissected whereas with strip, trained technicians can see everything they are doing under microscopic dissection. That said, many surgeons/clinics have been able to use their sense of touch or "feel" to harvest follicular units via FUE quite successfully without damaging them and ultimately produce outstanding results on par with strip.

 

 

I think this is a fair summary, it is a useful study. However I typed "Dr Beehner FUE" into google and could not see any results from him where he had practised FUE. Then I went to is website, Saratoga Hair Transplant Centre, and noticed he only will perform FUE in two very limited circumstances:

 

1. For use in camouflaging wide donor scars

 

2.For obtaining body hair when the scalp donor sites are depleted.

 

He goes on to say:

 

"If someone wants to preserve the option of shaving their head some day, then proceeding with hair transplantation makes no sense, even with FUE, as after a great many of these tiny punch-outs, in many patients a slight “moth-eaten” appearance can still occur which is not entirely natural looking. In summary, we think FUE has a valuable, but limited, role in hair transplantation and is a valuable procedure for us to be adept at performing, but that it will never be the preferred way to obtain donor hair for transplant procedures in general. It is simply too time-consuming, too tedious, and the surgeon and staff don’t have the same freedom and ability to cut perfectly sculpted grafts as with strips, in which case everything is carefully done under the microscope."

 

Based on this information, I surmise he does not perform FUE very much. This study may reflect the doc's inexperience with FUE and expertise in FUT.

 

A study performed by a doctor such as Feriduni or Bisanga who have regularly performed FUT and FUE for years would carry a lot more weight.

[Louisjams]

Interesting r.e. fail rates of FUE and FUT grafts. While this is only really a pilot study, it strongly argues that they need to test this on a bigger scale with more docs and patients.

[harin]

Good observation.

 

Also there could be inherent investigator bias about the FUE procedure.

 

I think this is a fair summary, it is a useful study. However I typed "Dr Beehner FUE" into google and could not see any results from him where he had practised FUE. Then I went to is website, Saratoga Hair Transplant Centre, and noticed he only will perform FUE in two very limited circumstances:

 

1. For use in camouflaging wide donor scars

 

2.For obtaining body hair when the scalp donor sites are depleted.

 

He goes on to say:

 

"If someone wants to preserve the option of shaving their head some day, then proceeding with hair transplantation makes no sense, even with FUE, as after a great many of these tiny punch-outs, in many patients a slight “moth-eaten” appearance can still occur which is not entirely natural looking. In summary, we think FUE has a valuable, but limited, role in hair transplantation and is a valuable procedure for us to be adept at performing, but that it will never be the preferred way to obtain donor hair for transplant procedures in general. It is simply too time-consuming, too tedious, and the surgeon and staff don’t have the same freedom and ability to cut perfectly sculpted grafts as with strips, in which case everything is carefully done under the microscope."

 

Based on this information, I surmise he does not perform FUE very much. This study may reflect the doc's inexperience with FUE and expertise in FUT.

 

A study performed by a doctor such as Feriduni or Bisanga who have regularly performed FUT and FUE for years would carry a lot more weight.

[Melvin- Admin]

Summary:

 

Based on this study of 1780 FU grafts in 4 patients, a projection can be made that:

 

11% of all FUT grafts will fail

43% of all FUE grafts will fail

 

I will gladly accept these numbers as true when pigs fly.

 

Remember this failure is based off one surgeon, and please keep in mind this one surgeon does not perform FUE regularly.

 

So in my opinion this study is useless sorry, but think of it this way, what if I created a "study" stating that by keeping my feet together I'm able to consistently make free throws in basketball, but while keeping my feet apart my consistency drops to about 50%. Does my own experience hold any sort of bearing over someone else's experience? Absolutely not, that study only shows how poor the doctor is at performing FUE sorry it's the truth.

 

In order for the study to be credible, you'll have to take identical twin patients with hairloss, have one FUT Doctor perform the surgery with a set amount of grafts, then the other patient have the surgery performed by an FUE surgeon with the same amount of grafts, this should occur with at least 10 set of identical twins with 10 FUT doctors and 10 FUE doctors, this will allow us to get a clearer understanding and have a larger pool to review.

 

Will this ever occur? No I don't think so, let's assume the difference is 10% and the visual difference is barely noticeable, then FUT physicians who are poor at performing FUE will lose business.

 

Here's another analogy for that study, it's like arm wrestling yourself with your right and left arm and coming up with the conclusion that all right arms are stronger than left arms lol.

[1978matt]

Absolutely not, that study only shows how poor the doctor is at performing FUE sorry it's the truth.

 

A juvenile and disrespectful comment as expected. You don't even know how he performs his FUE and it's not even a large case so fatigue doesn't even come into play. Why don't you call up Dr Beehner and advise him how to improve his technique? (Notice he's using the SAFE system, as does Dr Bhatti who's patients have presented a few mediocre results lately. Yield so bad they have large patches of bald scalp.)

 

In the link above we have 2 Coalition doctors (Bernstein and Beehner), with a combined experience of over 50 years who are concerned enough about FUE/FUT growth differences to be bothered to: a)Carry out a study or b)Look at ways FUE growth rates can be improved.

 

If FUE grows the same as FUT then why on earth would they bother? They all attend the ISHRS conferences and other seminars so why not pinch Dr 'X's technique and be done with it?

 

Readers, please don't fall for reps, internet gurus, or doctors claiming FUE has the same yield. The best they can get is something very close to FUT if you're willing to take an additional risk. It's up to you if that's a risk you're willing to take versus having a strip scar.

[esrec]

A juvenile and disrespectful comment as expected. You don't even know how he performs his FUE and it's not even a large case so fatigue doesn't even come into play. Why don't you call up Dr Beehner and advise him how to improve his technique? (Notice he's using the SAFE system, as does Dr Bhatti who's patients have presented a few mediocre results lately. Yield so bad they have large patches of bald scalp.)

 

In the link above we have 2 Coalition doctors (Bernstein and Beehner), with a combined experience of over 50 years who are concerned enough about FUE/FUT growth differences to be bothered to: a)Carry out a study or b)Look at ways FUE growth rates can be improved.

 

If FUE grows the same as FUT then why on earth would they bother? They all attend the ISHRS conferences and other seminars so why not pinch Dr 'X's technique and be done with it?

 

Readers, please don't fall for reps, internet gurus, or doctors claiming FUE has the same yield. The best they can get is something very close to FUT if you're willing to take an additional risk. It's up to you if that's a risk you're willing to take versus having a strip scar.

 

I tthink the "study" could have been conducted better, not sure anyone would argue there. The results were so concerning I think that's what prompted some of the other comments. Either way, its an alarming conclusion.

[Melvin- Admin]

A juvenile and disrespectful comment as expected. You don't even know how he performs his FUE and it's not even a large case so fatigue doesn't even come into play. Why don't you call up Dr Beehner and advise him how to improve his technique? (Notice he's using the SAFE system, as does Dr Bhatti who's patients have presented a few mediocre results lately. Yield so bad they have large patches of bald scalp.)

 

In the link above we have 2 Coalition doctors (Bernstein and Beehner), with a combined experience of over 50 years who are concerned enough about FUE/FUT growth differences to be bothered to: a)Carry out a study or b)Look at ways FUE growth rates can be improved.

 

If FUE grows the same as FUT then why on earth would they bother? They all attend the ISHRS conferences and other seminars so why not pinch Dr 'X's technique and be done with it?

 

Readers, please don't fall for reps, internet gurus, or doctors claiming FUE has the same yield. The best they can get is something very close to FUT if you're willing to take an additional risk. It's up to you if that's a risk you're willing to take versus having a strip scar.

 

Maybe it was a bit disrespectful I apologize to the doctor if I hurt his feelings but the truth is the truth, the only thing a study performed by one (1) surgeon proves is how good that surgeon is at both procedures.

 

Nobody said FUE grows the same as FUT on a *consistent basis key word there, a nearly 50% difference that's ridiculous and you know it, if FUE yields were so poor why would respected FUT surgeons like Shapiro have any interest in performing the procedure? Why would he attend FUE seminars hosted by Dr. Lorenzo and Erdogan? No disrespect to beehner or Bernstein, they were pioneers in their time with FUT but experience does not equate to skill, correct me if I'm wrong but Bernstein uses robotic FUE that should tell you everything.

 

(Link removed by moderator)

I believe what Dr. Shapiro says to be more reflective of FUE results today, in just the past 10 years the procedure has grown from 500 grafts to 5,000 grafts, would this be the case if yield was nearly 50% less than FUT? I don't think so. Notice he says a good "FUE transplanter" should be able to get *close to the same yield at least 80% of the time, a surgeon who only performs FUE in to strip scars etc. I don't think could be considered an FUE specialist or a good "FUE transplanter."

Edited November 27, 2015 by David - Moderator

[Dr. Michael Beehner]

Just to set the record straight, I thought I would summarize the findings of my 3-year, 4-patient study of 1780 follicles, comparing the approximately 1 year survival of FUE and FUT/microscope dissected grafts. I used the Safe-II system with the dull-edge punch for harvesting the FUE's. I looked at 1-hair, 2-hair, and 3-hair FU's, and these three different sizes all did about the same, with the 3-hair ones slightly ahead of the other two, but not statistically significant.

We placed the grafts carefully into sagittal slits of 0.8, 1.0, and 1.1mm in length respectively for the three different sized grafts.

One of the four patients was what I would call an "out-lier," in that his FUE survival was far worse than the other three. Only 33.6% of his follicles grew hairs. He did, however, have respectable FUT growth at 83%, so it's not clear if the occasional (perhaps 1 in 10 or 20) patient has a result like this with FUE, or whether this is truly rare and shouldn't be counted in my study. I will below list how the two different kinds of grafts did in each of the four patients. I will then summarize the final survival rate of "findable" hairs at 11-14 months for all four patients taken together and then for only the three patients, minus the out-lier.

 

FUE FUT Difference

 

Patient #1 74/220 (33.6%) 183/220 (83%) 49.4 %

 

Patient #2 163/220 (74.1%) 192/220 (87.3%) 13.2 %

 

Patient #3 187/250 (74.8%) 238/250 (95.2%) 20.4 %

 

Patient #4 123/200 (61.5%) 152/200 (76%) 14.5%

 

All patients combined: FUE......547/890 (61.4%) FUT......765/890 (86%)

 

Three patients

(minus the "out-lier") FUE.......473/670 (70.1%) FUT.......582/670 (86.9%)

 

Are these percentages applicable to everyone who does FUE? I don't know. I would assume that those who do FUE all the time may have better numbers. I am also quite sure that the newcomer to FUE, especially the physician who delegates most of the tasks to staff, do much, much worse. This is only the beginning of our effort to find out the real difference. I had performed around 105 FUE cases prior to my doing this study, so I'm certainly in the middle group of reasonably skilled FUE surgeons. Additional studies are under way and it will be interesting to see how they all turn out. As a guidepost to use in judging the above, a few years ago I did a "meta-analysis" of every study done up to that date of FU survival (these were all done from a strip and microscopic dissection) and the 29 studies I looked over averaged 89.4% survival of FU's; that is, one year later, this was the percentage of terminal hairs that could be seen relative to the number of follicles planted.

The big difference between FUE and FUT grafts is that FUE grafts have to be "plucked" free from their bottom-most attachment, and this action very often results in most of the protective fatty tissue being stripped off of the graft, thus leaving it more susceptible to drying and to trauma in handling during the placement phase. Another important point is that my study and others only start out with the grafts that make it to the starting line. In FUE, especially with sharp-edged punches, there are a fair number of follicles that are transected as they veer away from each other beneath the skin. Often the follicles are like seaweed, and a straight, cutting surface will cut across many of the follicles. Some defend this by saying that the transected hairs will grow anyway, but one recent reference I read stated that only 60% of transected FUE follicles resulted in a visible hair later on.

My personal opinion is that harvesting with a strip method and then cutting the grafts perfectly under the view of a microscope remains the "gold standard" for hair transplantation. That being said, I think there are many instances, certainly in my practice, where it is imperative that every hair surgeon should know how to harvest grafts well using FUE. There is a long learning curve to becoming proficient at FUE. Also, with each patient the first 20 to 30 grafts are a process of "getting to know" that person's unique hair and follicle structure, as they are all different regarding angle, how deep to drill with the punch, how large a punch to use, etc. etc.

 

Michael Beehner, M.D.

Saratoga Springs, New York

Edited November 28, 2015 by Mike Beehner, M.D.

[esrec]

Just to set the record straight, I thought I would summarize the findings of my 3-year, 40-patient study of 1780 follicles, comparing the approximately 1 year survival of FUE and FUT/microscope dissected grafts. I used the Safe-II system with the dull-edge punch for harvesting the FUE's. I looked at 1-hair, 2-hair, and 3-hair FU's, and these three different sizes all did about the same, with the 3-hair ones slightly ahead of the other two, but not statistically significant.

We placed the grafts carefully into sagittal slits of 0.8, 1.0, and 1.1mm in length respectively for the three different sized grafts.

One of the four patients was what I would call an "out-lier," in that his FUE survival was far worse than the other three. Only 33.6% of his follicles grew hairs. He did, however, have respectable FUT growth at 83%, so it's not clear if the occasional (perhaps 1 in 10 or 20) patient has a result like this with FUE, or whether this is truly rare and shouldn't be counted in my study. I will below list how the two different kinds of grafts did in each of the four patients. I will then summarize the final survival rate of "findable" hairs at 11-14 months for all four patients taken together and then for only the three patients, minus the out-lier.

 

FUE FUT Difference

 

Patient #1 74/220 (33.6%) 183/220 (83%) 49.4 %

 

Patient #2 163/220 (74.1%) 192/220 (87.3%) 13.2 %

 

Patient #3 187/250 (74.8%) 238/250 (95.2%) 20.4 %

 

Patient #4 123/200 (61.5%) 152/200 (76%) 14.5%

 

All patients combined: FUE......547/890 (61.4%) FUT......765/890 (86%)

 

Three patients

(minus the "out-lier") FUE.......473/670 (70.1%) FUT.......582/670 (86.9%)

 

Are these percentages applicable to everyone who does FUE? I don't know. I would assume that those who do FUE all the time may have better numbers. I am also quite sure that the newcomer to FUE, especially the physician who delegates most of the tasks to staff, do much, much worse. This is only the beginning of our effort to find out the real difference. I had performed around 105 FUE cases prior to my doing this study, so I'm certainly in the middle group of reasonably skilled FUE surgeons. Additional studies are under way and it will be interesting to see how they all turn out. As a guidepost to use in judging the above, a few years ago I did a "meta-analysis" of every study done up to that date of FU survival (these were all done from a strip and microscopic dissection) and the 29 studies I looked over averaged 89.4% survival of FU's; that is, one year later, this was the percentage of terminal hairs that could be seen relative to the number of follicles planted.

The big difference between FUE and FUT grafts is that FUE grafts have to be "plucked" free from their bottom-most attachment, and this action very often results in most of the protective fatty tissue being stripped off of the graft, thus leaving it more susceptible to drying and to trauma in handling during the placement phase. Another important point is that my study and others only start out with the grafts that make it to the starting line. In FUE, especially with sharp-edged punches, there are a fair number of follicles that are transected as they veer away from each other beneath the skin. Often the follicles are like seaweed, and a straight, cutting surface will cut across many of the follicles. Some defend this by saying that the transected hairs will grow anyway, but one recent reference I read stated that only 60% of transected FUE follicles resulted in a visible hair later on.

My personal opinion is that harvesting with a strip method and then cutting the grafts perfectly under the view of a microscope remains the "gold standard" for hair transplantation. That being said, I think there are many instances, certainly in my practice, where it is imperative that every hair surgeon should know how to harvest grafts well using FUE. There is a long learning curve to becoming proficient at FUE. Also, with each patient the first 20 to 30 grafts are a process of "getting to know" that person's unique hair and follicle structure, as they are all different regarding angle, how deep to drill with the punch, how large a punch to use, etc. etc.

 

Michael Beehner, M.D.

Saratoga Springs, New York

 

Great write-up, thank you doctor. At minimum, I think its clear that FUE is significantly more tempermental than FUT and demands a hands-on approach to achieve similar or equivalent results. Your results only confirm that.

 

In light of what we've seen and heard lately, with many FUE doctors delegating much of the procedure to technicians, we have a disaster just waiting to happen if this trend continues.

[Dr Blake Bloxham]

Dave,

 

Nice summary. Thanks for sharing.

 

Dr Beehner,

 

Thank you for sharing some additional information. Frankly, the study design and execution appear quite well organized and refined to me. Furthermore, I think some of the "issues" being brought up have more to do with the objective results and less with the methodology. If the results showed that the FUE grafts were more reliable or grew closer to that of the FUT grafts, I don't think there would be anywhere near as many complaints.

 

However, that's not what the research showed.

 

As many doctors with the ability to offer both FUT and FUE have now pointed out, it showed that FUE yields are significantly lower than the FUT counterpart.

 

A few other comments on the study:

 

-First, there are -- in my opinion -- two different ways to look at the sample size (n): you can look at it as 4 -- if you're focusing on the number of subject participants -- or you can look at the n as 1,780 -- if you think of the subject of the study as the grafts. Four patients is a smaller sample size -- though one that is completely normal for studies of this nature; however, an "n" of 1,780 is large enough to fall into the realm of statistical significance.

 

-Second, performing FUT and FUE into the same scalp at the same time is an excellent way to reduce outside variables as much as possible. Trying to compare growth rates using different techniques on different scalps simply introduces too many factors that can affect the outcome and skew the conclusions. This is the same way Shapiro medical is approaching their upcoming FUE vs FUT growth rates study, and I really think this method should be continually replicated (and on larger scales if possible).

 

-Third, it's clear based on the images Dave shared that these FUE grafts were removed properly. The grafts look excellent. Like you noted, Dr Beehner, the roots are slightly splayed and the lower third portion of the grafts is stripped of the supportive tissue, but this is unavoidable with traditional FUE. But the grafts otherwise look as they should, and the picture shared should disprove any notions that the grafts were removed with anything besides the utmost care.

 

-Fourth, your point about only being able to evaluate the FUE grafts that actually make it out of the scalp in acceptable shape is a very important one. FUE grafts should truly be inspected under microscopes before implantation. Grafts that aren't acceptable shouldn't be implanted.

 

-Fifth, I think your final comment is dead on: FUT remains the "gold standard," but clinics should really be proficient in both -- as there are good indications for FUE.

 

Again, nicely done!

[james84]

Would be interesting for an FUE only Doc to take this study. Bore me the details.

[newbie33]

Very interests results. Would be fascinating to repeat this with different doctors performing the surgery, especially those who regularly do large fue sessions. Dr Josephitis from Shapiro shared a similar fue study on here recently and it really didn't get as much interest as it should have done.

 

Dr Beehner, is an 86% graft survival for your strip work what you expected/normal for your strip results? And on the fue graft extractions, did you implant all you extracted, including any transected grafts? And if not, how many were extracted but 'wasted'?

[Dr. Michael Beehner]

Newbie,

Thanks for posting your reactions to the study I did. I agree that it would be interesting to have a hair surgeon who primarily only does FUE now to conduct a study similar to mine. It would only have meaning if that physician was good at doing FUT hair transplantation prior to having switched to FUE. Otherwise the FUT results will be unnecessarily handicapped and low. I think the average of 86% for the four patients I chose was "in the ballpark" for what most studies have shown. One of the patients had a 95% FUT survival, but the oldest of the gentlemen had an atrophic, think scalp and only had a 76% survival, despite our carefully placing each graft. As I said, the sum average of all of the studies I could find 4 years ago was 89% and you have to remember that a lot of these studies were done in bare scalp areas with nothing else around them, only the study grafts in the middle of virgin scalp with virgin blood supply. The study boxes for these four men were surrounded by a large, dense number of FU and MFU grafts.

Regarding whether we placed all the grafts in, the answer is that for the "capped" grafts, that is, those in which the top portion broke off and the bottom two-thirds was left in the scalp, no, we didn't plant that little piece of the top of the follicle. For grafts that were plucked out but were seen to have a transection of at least one of the follicles, we did plant all of them, but not in the study boxes. The patient received them elsewhere. I would estimate that either capping or mid-follicle transection with full removal of the graft occurred in somewhere around 5% of the attempts. Each patient is different and I'm sure the percentage of these occurrences was different for the four men.

A lot of hair surgeons and clinics glibly tell their patients that 95% or 100% of the follicles survive, but I can assure you they are saying this based on optimistically "eye-balling" their results and not from having done any careful studies on their own patients.

Mike Beehner, M.D.

[newbie33]

Thanks Dr Beehner. Very comprehensive response and much appreciated.

[matt3480]

The results need to be taken for what they are....they are anecdotal. Four people is absolutely not enough to be statistically significant. You can't cherry pick stats. If you are saying 43% of FUE grafts won't grow.....then you are admitting 13% of FUT don't grow, either...and I don't think anyone would be OK with three of those four results posted for the FUT, either (meaning the 83, 87 and 76 percent yields posted given we are to expect 95-98 percent yield). It's simply one study by one doctor on 2 patients. Another doctor might have 90% yield versus 95% for FUT in 4 patients. That isn't necessarily indicative of anything either. Yes, generally we know FUE yields less and we know why. However, to imply it's 43% is a bit misleading given that people will run with these numbers as gospel, unfortunately. I'll tell you this much....my yield was sure as hell much higher than 57% on FUE (I bet it was easily in the 90s).

 

There are balances and trade-offs then. Would you be OK with the 97% FUT satisfaction rate if you have the chance the scar might not heal correctly? Would you be OK with 90% FUE knowing the scar won't be of significance? Most would. The scar thing is patient-dependent, too. You could get the nicest and most undetectable scar from a doctor...but if you stretch it or have a tendency to scar badly....no doctor is going to be able to account for that or fix that.

 

I know this. Go. to. a. good. doctor. That will severely limit yield issues. I'm sure Dr. Beehner is a great doctor....but both yields would not be acceptable that came up in his FUT/FUE study....so what is the common denominator there? We've seen his work...we know darn well we've seen pics of his patients with much more than 87% yield for FUT (so the stats almost aren't even statistically significant for him)....so the point is you need to take these numbers with a grain of salt. They are NOT statistically significant and these numbers can vary greatly based on the doctor and his skill and the patient and their physiology.

 

I would love to see stats from the FUE top doctors, too. Even that would not be gospel as to FUE rates...it would just be FUE rates for those doctors. It's like batting average in baseball.....a guy hits against the top 20 pitchers in a 20 game stretch and hits .200. We compare him to a guy who hits against the statistically worse 20 pitchers in baseball and he hits .400. Does it mean the second player is a better hitter than the first? No.

 

Blake, how realistic would it be for FUE doctors to actually look at these grafts under microscope....would this be a ridiculously time consuming thing (especially since you want to keep these out of body for as little time as possible). Honest question....I just don't know.

[Dr. Michael Beehner]

Matt,

I did say that the FUE growth percentage was 70.1% for the three patients, minus the "out-lier" who had very poor FUE growth. I agree with you that it would be nice if docs doing all-FU did a good study of how many can be found a year later, but they have not happened. I do think there are a few in the offing now and it will be very interesting to see what their percentages are.

Mike Beehner, M.D.