FUE or STRIP for a big case?

[Ganderson]

First of all I want to thank everyone who has responded and helped me in the past - this is a pretty supportive and knowledgeable community for the most part, and it seems like people here genuinely want to help one another - so thanks!

 

I've gotten a few consultations, all from recommended doctors and some that are mentioned among the "top" on this site. (the ones that you see when people talk about the top 3).

 

I'm going to post pictures below the outline the total hair loss and the potential, but here is what I have heard :

 

I am a norwood 5,5A, or 6, with unlikelihood to go to a 7.

 

I do not take propecia anymore, I was on it for a little while and was very unhappy with the effects. I actually didn't know much about the effects before starting, and unfortunately i got them pretty severely. if you dont, then great!

 

I am getting a full SMP done in about 6 weeks - only within the current hairline, and only because i am definitely getting either FUE or FUT at some point. This is only to create a base to get rid of the tan colord skin.

 

The doctors have all told me I have EXCELLENT laxity. One of them actually said that it was the most loose they have ever had a scalp (This is what turned me on to FUT in the first place, I thought H + W could get more out of my head, but it sounds like overall, at the end of the day, we are talking about 1-2000 grafts of difference?)

 

Plan 1

 

Get FUT done with H + W, Konior, Etc. 5 thousand grafts minimum, try to get as much coverage as possible. Go back one year later, try to get as much as I can, and then maybe get some FUE's down the road with hair and beard ( i wont go to body hair, if it is headed there then i'd rather just go with plan 2).

 

Thoughts?

 

 

Plan 2

 

I will go to a different doctor than the ones above as some of the costs for FUE are in the 10.00 range, and I would like to get 10,000 grafts. Who is the best surgeon bang for buck, with the best results and does FUE? I am thinking I either get FUE with one of these doc's and hope for the best, or if not, get a decent hair line and combined with SMP ill keep it at a 1 length or so, dusting my whole head with 3-4000 FUE's.

At the end of the day I think everyone who wears different hairstyles would like to keep the option open of keeping their hair short, but if its a "either do FUT or do nothing scenario" then I would like to know, and I'll do it, but I just want to get good coverage and look good.

 

Not expecting a full head of perfect hair, just dont want to look like im balding. Higher hairline, not super dense, but not something anyone would question or think twice about. "His hair is fine, not bad, not great, its not a part of something I would judge".

 

What do you guys recommend, if anything

 

Please see below for all the pictures.

[Ganderson]

More Pictures.....

[Ganderson]

Thanks in advance for any of your suggestions, help, or advice. I would be glad to share anything that I have discovered in the last few months as well!

 

Also... a little more background...

 

I've been shaving my head this length for the past 10 years. I just dont like the receding hairline, the bald spots, etc. I never got to experience hair ( I was an athlete and we all shaved our heads for years) so now that I have come to an age (28) where i want it, I cant have it. So, what do you guys recommend.....

[Bill - Seemiller]

Honestly, I think it depends however I'm a firm believer that combining both strip and FUE is the best way of maximizing your donor hair and getting the most out of your hair transplant. Thus, as long as you are a candidate and have the scalp elasticity, I suggest considering starting with strip and getting as much as you can from multiple procedures and then finishing off with FUE.

 

For example, in my case I've had over 9600 grafts with strip and probably have another 2000 or three S and probably have another 2000 or 3000 available grafts via FUE if I want them. Sometimes I consider getting some crown worked on using FUE.

 

I hope this helps.

 

Bill

[Ganderson]

Thanks Bill! Based on what you are seeing here, what do you think my results would be like, going to with Konior, H + W, etc? Am I right to want to push for the max, or in my case, will it stil be "so so" and will i get a better result just doing FUE and SMP and keeping my hair buzzed to a one or something. At the end of the day, I just want it to look normal.

 

Also, I was reading about these mega sessions of getting 5-7000 grafts in one session, is it true that they only do that by transecting the strip and calling it more grafts, or does someone like H + W actually have a procedure where they can extract 1-2000 more grafts than konior?

[1978matt]

I think it could look great with 5000+FUT. Despite the scar you should still be able to go to a grade 4 back and sides which is only 12mm.

 

With such high numbers of FUE grafts the doc is going to be venturing into unsafe parts of the donor area, that is if you want to be able to shave down quite close in the future.

 

If you do go FUE I'd stick with 2500-3000 to start with just to be sure your follicles can withstand the extra stresses involved.

[Stig]

Thanks Bill! Based on what you are seeing here, what do you think my results would be like, going to with Konior, H + W, etc? Am I right to want to push for the max, or in my case, will it stil be "so so" and will i get a better result just doing FUE and SMP and keeping my hair buzzed to a one or something. At the end of the day, I just want it to look normal.

 

Also, I was reading about these mega sessions of getting 5-7000 grafts in one session, is it true that they only do that by transecting the strip and calling it more grafts, or does someone like H + W actually have a procedure where they can extract 1-2000 more grafts than konior?

 

Seeing you are a higher NW, definitely go with strip FUT until stripped out and then switch to FUE. H&W are more aggressive with their strips than Konior. They tend to take the strip higher, and go longer, potentially all the way to your forehead to get the max number of grafts. Its a matter of preference whether you can live with the scar so long and on the high side. Seeing you are a higher NW, I think it would be beneficial for you take the more aggressive route. With only FUE, you just wont get the same number of grafts and therefore less coverage than you would going the strip/FUE combo.

[Melvin- Admin]

Manderson I think everyone would agree that combining both will get you the most grafts. However, you must be willing to live with the strip scar for life, I personally chose the FUE route I am Norwood 6, this was my personal decision based on hairstyle preference but there is no doubt I could've gotten more grafts combing both, it's really personal preference and long term strategy, I knew going in to surgery the disadvantages of FUE.

 

If you don't care about the scar or don't ever want to cut your hair short, going strip without a doubt will be more cost effective and will give you more grafts per session, I would choose Dr. Hasson, he's miraculous on high Norwoods, Wong is too, he does his strips a little higher near the lateral humps though, but that area is generally safe for Norwood 6's. Also, remember it's important to be realistic, my hair looks good in most situations, but there are times where weaknesses show, having realistic expectations is vital to the success of your procedure.

[gillenator]

The only thing that I wanted to add was that these mega-sessions can induce a higher level of trauma to the scalp. I have observed over the years that when the trauma level is increased, the yield factor can decrease. Obviously not everyone is going to agree with me however my opinion is again based on a large number of cases observed over the years and something to consider.

 

So you might want to consider having two large FUHT procedures of approximately 3,000 grafts each to maximize the yield. Starting with the frontal third and then going back in a year for the second procedure will give you a good barometer on how well you like how the frontal third came out.

 

Since you are destined to reach the advanced class of the Norwood scale, your grafts are precious and maximizing the yield is an important part of the equation along with having some donor reserves for the future.

 

If you decide to have a 6,000 graft FUHT procedure, that's a substantial size strip and would undoubtedly go ear-to-ear and hard to say how wide it would be not knowing your donor density level. Regardless, you will need above average scalp laxity to accommodate a strip that large. Doing this in two procedures would also reduce the size of the proposed strip to also help ensure a nice thin donor scar.

 

Something to think about before the procedure and best wishes to you...

[Melvin- Admin]

For some reason my last post got flagged, mega session can decrease yield I agree with gillenator, I chose FUE I'm also Norwood 6 two sessions totaling 4,000 grafts, I'm going this year for my 3rd hopefully I can get another 1,500, which would put me at 5,500 and in the future I'll use beard hair as filler hair for density, if you don't mind the scar or don't ever want to wear your hair short go FUT it's cheaper and you can move more grafts at once. It's a personal decision, but once you choose whichever there's no going back so think about it.

 

Edit: I just realized you're getting smp, I strongly recommend doing trichopigmentation which is not permanent, I also recommend getting that after you've had your surgeries, I think it's a great tool to use to camoflauge fue scars or as a thickener, but you should do this after your procedure so it's easier for the surgeon and its utilized better by the trico technician.

Edited January 29, 2016 by Melvin-HTsoon

[Ganderson]

Thanks guys....

I'm a little more confused than ever now...

 

 

everyone told me before to do as much as possible in the first setting because scalp laxity goes down....

 

 

The truth is... I want to get FUE... But what's the difference in the amount of grafts j can get? Will I get 10k with fut and fue combo? Will I get less or more? I don't know what to do!!!

 

Also - who are the best FUE docs.... Are there any with more reasonable prices than 9 dollars a graft ... I was told I can get a solid 10k grafts out of me through FUT, I don't really want to pay 90k for the procedure

[Ganderson]

Also....

 

I'm from IL, so konior is close by (if I go the strip route , which everyone seems to be recommending) should I go with konior or should I choose H + W?

[Ganderson]

HTsoon your results are incredible.

 

I'm worried that as I get older (next 10-20 years) I may want a shorter hair cut, but wouldn't be able to Achieve it because of the scar?

[mav23100gunther]

Thanks guys....

I'm a little more confused than ever now...

 

 

everyone told me before to do as much as possible in the first setting because scalp laxity goes down....

 

 

The truth is... I want to get FUE... But what's the difference in the amount of grafts j can get? Will I get 10k with fut and fue combo? Will I get less or more? I don't know what to do!!!

 

Also - who are the best FUE docs.... Are there any with more reasonable prices than 9 dollars a graft ... I was told I can get a solid 10k grafts out of me through FUT, I don't really want to pay 90k for the procedure

 

Yes, if choosing FUT, I personally prefer to go with larger mega-sessions so that you limit the number of times you have to get a strip cut out. I know others make a case for more smaller sessions. Pros and cons to both. Yes, depending on your donor and scalp laxity, patients going with H&W seem to be able to get in the higher numbers. When I consulted with Dr Hasson, he thought I had around 7,000 to 8,000 grafts remaining after my 1st procedure with a diff surgeon that took around 2,000 grafts. Dr Rahal, estimated around 4,500 to 5,000, so yes, H&W seem to get more than other strip doctors. In your case, I like Hasson over Konior

 

For FUE, I wouldn't use a North American surgeon. The best FUE surgeons are actually in Europe for around 3 Euros a graft and less. Look at Feriduni, Bisanga, Lorenzo, Erdogan. You may want to consider Erdogan as he routinely performs larger FUE mega-sessions of 5,000 grafts in a single visit.

[MrGio-WHTCClinic]

A combination of FUT and FUE are used when you would like to achieve the maximum amount of coverage in a single session. Donor recharging with beard hair is another option to maximize your donor resources from the scalp.

 

To make a better decision, you'll need to think about how you intend to style your hair in the future. It seems that you may want to keep your hair short. The laxity of the scalp is a factor in strip harvesting, but it doesn't guarantee a pencil-thin strip scar in the donor region.

 

Ink onto the scalp will require maintenance.

[Melvin- Admin]

HTsoon your results are incredible.

 

I'm worried that as I get older (next 10-20 years) I may want a shorter hair cut, but wouldn't be able to Achieve it because of the scar?

 

The biggest deciding factor for me was the fear of future hairloss, God forbid my sides drop and I'm left with an island of hair, at least with FUE I could buzz my head, yes the FUE scars would be visible but with trico pigmentation I think it would camouflage well, if you go FUT that scars for life, and even getting FUE in to the scar doesn't completely camouflage it, that is the dilemma high Norwoods face, on one hand FUT allows you to utilize more grafts, at the same time if you have future hairloss progression, forget about ever buzzing your head.

 

Unfortunately, I can not tolerate fin so my only alternative was to FUE as much as possible, try and achieve full coverage and utilize BHT as filler hair for density, you have to map out a plan manderson, think of what could occur in the future, hope for the best but plan for the worst. To answer your question, I think the difference in the amount of grafts you could get from just FUE to a combination could be around 3-4,000 grafts.

[Melvin- Admin]

HTsoon your results are incredible.

 

I'm worried that as I get older (next 10-20 years) I may want a shorter hair cut, but wouldn't be able to Achieve it because of the scar?

 

My posts keep getting flagged, have you worn your hair short? I have never worn my hair long, I grew my hair long once and I looked like weird so its not a good look for me, if you look good with long hair it shouldn't matter, the really only concern is that if you ever progress to an unmanageable hair loss progression like norwood 7 you'd be stuck with an island of hair, its highly unlikely though from where your at right now, but still its something that has stayed in the back of my mind, i've consulted with two different doctors who've told me that they don't see me progressing to norwood 7 but Dr. Lorenzo is highly adamant on the use of Finasteride and says that the sides may drop, unfortunately for me I can't tolerate finasteride, I will say though that I consulted with Dr. Umar in person and he said he doesn't see me progressing to norwood 7. Nevertheless, I have more peace of mind that I chose FUE cause if that ever happens ill buzz my head and trico the FUE scars, I'd do touch ups every few years and keep my head buzzed.

 

Go in to in person consults, get a pool of doctors opinions and then decide from there, if you have any fear of ever progressing to norwood 7 then having that strip scar could be a killer.

[Ganderson]

I have a couple of fears HTsoon and you touched on some.

 

I'm worried that I may progress to an unmanageable point - it's a fear and I don't think it's totally irrational, even though Several doctors said it was very unlikely. But nothing is impossible (their words).

 

 

I also don't know how I will look with long hair, so that's a risk too.

 

Also, shaving my head while I'm waiting for it to grow in is a huge plus - I don't know how that 6 months of waiting will be and I'm a little scared for that too.

 

So a large FUE session by erdogan followed by 1-2 more, maxing out my grafts from head and beard sound pretty good... Followed by SMP.

 

BUT, I just don't want to regrets using everything up and not going with strips that will probably give me better and more coverage. It's not easy for large cases, I don't feel like I can prepare much more :-(

[Ganderson]

In addition, another reason FUT sounds good is because my scalp laxity is "the most loose scalp we have ever seen" from several doctors, one considered one of the best in the country. They still didn't want to push me one way or another - which I understand, for men, this cosmetic procedure could be the biggest in terms of effect. It's interesting how hair, the loss of it, the progression, affects all of us so deeply.

 

It sounds like I may be complaining and hopeless but the opposite is true. I know that had I been older or worse off, I wouldn't have these options at such a young age. I'm grateful for what's out there- it's CLOSE to perfect! If I can get to 75% of having a good head of hair, how can you really complain about much. Sounds like everyone has an option for improvement!

[Melvin- Admin]

I have a couple of fears HTsoon and you touched on some.

 

I'm worried that I may progress to an unmanageable point - it's a fear and I don't think it's totally irrational, even though Several doctors said it was very unlikely. But nothing is impossible (their words).

 

 

I also don't know how I will look with long hair, so that's a risk too.

 

Also, shaving my head while I'm waiting for it to grow in is a huge plus - I don't know how that 6 months of waiting will be and I'm a little scared for that too.

 

So a large FUE session by erdogan followed by 1-2 more, maxing out my grafts from head and beard sound pretty good... Followed by SMP.

 

BUT, I just don't want to regrets using everything up and not going with strips that will probably give me better and more coverage. It's not easy for large cases, I don't feel like I can prepare much more :-(

 

You have valid concerns, I think a lot of guys that are not high norwoods don't think of, whilst your hair transplant grows, you're going to have to grow the sides out, so basically you will look like crusty the clown for up to 6 months, don't over think it Manderson, if you want to utilize the most grafts go FUT and FUE after.

 

Another thing, I do not think FUE mega session are the way to go, there is a high chance that your growth will be diminished, not only that but taking 4,000 grafts FUE at once could seriously impact your donor area, its best to do FUE in sessions, think of all the angles, weigh the pros and con's I will list my pros and cons for you:

 

 

• FUT allows you to utilize more donor hair in the sweet spot
  
• FUT will keep the hair above the strip scar virgin for FUE extraction
  
• FUT is cheaper
  

 

• FUT grafts are less fragile so growth is not as diminished in Megasessions although growth would probably better if you split the procedures up.
  

 

• FUE allows you to wear your hair short whilst the grafts grow in so you don't look terrible in the mean time.
  
• FUE allows doctors to cherry pick grafts, this is contested but its only logical, when you see the donor area as a whole you can see where hairs are thicker and wear hairs are finer, so surgeons can extract accordingly.
  
• FUE provides somewhat of a safety net if you ever progress to an unmanageable hairloss scale, the tiny scars are a lot easier to camouflage.
  

 

cons

• FUT scar can stretch, making significantly impacting the look of your donor, forget about ever shaving your head, you'd be pretty much stuck.
  
• FUE is more expensive and you will have to have more surgeries to get the desired result.
  
• FUT takes longer to recover from, and you have to grow your hair on the sides long while still remaining bald on top for months.
  
• FUE is limited in the amount of grafts that could be taken because the overall donor is thinned, although you could opt to really thin the donor out, it may look odd when its grown out.
  

[mosd]

its a tough one really. I went for FUT and somedays i freak out about my decision. What the fuck will happen if i turn to nerwood 7?! Then im screwed and there is not much i can do about it.

 

Other days i think like this : Ok, so how likely is it that i turn to nw7? And if i do, i can fue hairs into the scar and even smp on top of it. Will it look perfect? Nope. Will it look ok? Probably.

 

If i keep on finasteride, and combine fut and fue i have about 10 000-11 000 grafts i can use. That is a alot of grafts. With fue i would have about 6000-7000.

[thisguy1]

Seeing you are a higher NW, definitely go with strip FUT until stripped out and then switch to FUE. H&W are more aggressive with their strips than Konior. They tend to take the strip higher, and go longer, potentially all the way to your forehead to get the max number of grafts. Its a matter of preference whether you can live with the scar so long and on the high side.

 

I agree H&W is going to get more aggressive as they do bigger sessions but Konior went all the way to the sides (or as you called it "forehead") with me. My strip is "end to end" if you'd like to call it that. So for high norwood he will go "all the way around" like H&W does.... but maybe a bit lower strip than H&W in the back to be 'conservative'.

 

I have not seen many 4K+ with Konior here; only a handful. And those are low 4000s. Whereas you do see 5K+ in 1 sitting with H&W relatively often.

[thisguy1]

Thanks guys....

I'm a little more confused than ever now...

 

 

everyone told me before to do as much as possible in the first setting because scalp laxity goes down....

 

 

The truth is... I want to get FUE... But what's the difference in the amount of grafts j can get? Will I get 10k with fut and fue combo? Will I get less or more? I don't know what to do!!!

 

Also - who are the best FUE docs.... Are there any with more reasonable prices than 9 dollars a graft ... I was told I can get a solid 10k grafts out of me through FUT, I don't really want to pay 90k for the procedure

 

FUE is cheaper in Europe. I was just poking around at some and I saw Bisanga has 5 euros for first 1k grafts and then 3 euros for each after. The dollar has risen quite a bit vs the euro the past year so it makes the surgery much cheaper there than say 2 years ago. Its basically 1 to 1.08 or so so a 6000 euro surgery is like 6500 dollars.

 

This is very different than even 2 years ago - in early 2014 the exchange rate was close to $1.40 USD to each euro meaning a 6000 euro surgery 2 years ago was costing an American $8400. Today it's $6500.

 

You would never pay $90K for "mostly FUT" - FUT is cheaper in the U.S. than FUE by a decent margin. I mean even going with the most expensive US/Canada guys with FUT for 10K you probably would be talking under $45K (I am assuming 2 or 3 FUT surgeries). And that's the most expensive ones.

 

Back to Bisanga, FUT was even a bit cheaper with 3 euro for first 2000 grafts than only 2 euro for each after. So you could do 4000 grafts in 1 sitting for about $10,500. Plus your travel costs. Again with the exchange rate nowadays 3 euros is like $3.15 a graft and 2 is like $2.10 a graft. In the U.S. you usually go with $5 a graft for the first X thousand grafts (usually 2 to 3 thousand grafts depending on clinic) and then it drops to $3 for additional grafts for the top top reviewed guys. Honestly the Bisanga rate is a substantial reduction vs H&W, Konior, Shapiro where you will pay probably $15Kish for similar (+/- $1000 for each doctor) FUT.

 

I am not recommending or not recommending him - just giving you an idea of the price difference. The US dollar rising the last year has made "out of country" prices cheaper to Americans.

 

If you are considering Rahal in Ottawa he is actually relatively cheap too as the dollar has risen vs the Canadian dollar as well but not as cheap as the 2 European ones I looked at. But people here like his FUE in general if you want to go that route.

 

But yes as everyone says for "maximum" yield out of your head you basically will do 2 FUT (some people can manage 3) to get you 8K+ grafts (some people more) and then FUE to finish it out. Most people (not all) would be able to get 10K grafts if this is your process - obviously NW7s and certain candidates would be exempt. If you go FUE ONLY most will say you wont get 10K without substantial risks and just gambling hairs are not going to be transplanted from areas where MPB won't eventually hit. And "mothball" look potential from donor area. Seems like many think 6-7K grafts is a good target for FUE ONLY to ballpark it but every person is different.

Edited February 1, 2016 by thisguy1

[HairJo]

I think you will get more with a strip and every hair is precious. Good luck in whatever you choose

[Ganderson]

Do you think it makes sense to get 1-2000 beard hairs, and do a thousand regular hairs, all FUE, just to fill in the gaps for now, and then get an FUT once I feel comfortable with my hair looking all filled in and everything? Might make sense, and I wouldnt really deplete the good STRIP areas at all by doing this (only 1000 from the head?)