When Strip is Better Than FUE, Dr. Cooley, 1535 Grafts

[HairCenter]

FUE has certainly made a huge impact on the hair restoration industry and has really found it's stride over the past few years. Dr. Cooley has been performing FUE on a regular basis since 2010 and it is an invaluable option for our patients. Sometimes patients want to have FUE but may be better candidates for strip instead but this all depends on a multitude of factors. Being very proficient in both methods allows Dr. Cooley to provide either option, or both in some cases, to patients depending on their needs and wishes.

 

The case below is one case where FUE was requested but FUSS was indicated as being the better option. The patient is in his late thirties and had already undergone one FUE procedure of 1500 grafts with another local clinic one year prior to his visit to us at Hair Center. The grafts from his FUE surgery were not placed into the hairline but were sprinkled throughout the top of his scalp. He felt that while there was an improvement he could not distinguish if his improvement was from the surgery or from his recent use of finasteride.

 

When the patient came to us he wanted to have another FUE to thicken the frontal zone and to add density to his hairline. He liked the shape of his hairline and Dr. Cooley agreed that it should not be drastically altered so the plan was to move another 1500 grafts (1535 to be exact) to reinforce the frontal zone including the hairline. The result shown is ten months post-op.

 

Why would FUE not be indicated for such a small procedure? Because the already small FUE procedure he had undergone the previous year drastically thinned his donor zone. We could have moved another 1500 grafts from the rest of his donor area by creating a wide extraction pattern. This would have given us a more homogenous appearance however the potential problems of dealing with another clinic's previous work made FUSS the better choice as the patient was not happy with the idea of thinning his donor zone further.

 

 

 

 

 

 

 

 

 

 

 

 

 

[delancey]

Out of curiosity, what yield can one expect from an FUE procedure at Dr. Cooley's clinic?

[lakes9925]

what is FUSS?

[Dolph1969]

Nice work, but get those eyebrows trimmed ffs...

[andy_+_+]

Nice result.

 

Very interesting how much donor damage was done with such a small FUE procedure.

[TakingThePlunge]

what is FUSS?

 

FUSS stands for follicular unit strip surgery and is a more accurate term for differentiating strip from FUE than FUT or follicular unit transplantation. This is because both FUE and strip involve the transplantation of follicular units. Our community prefers the use of FUSS to describe strip surgery.

[TakingThePlunge]

Excellent result!

[MrGio-WHTCClinic]

The donor region looks great.

[Janna]

Brilliant treatment and result! Implementing Finasteride seems to have helped in the overall density too.

[Pete-from-Farjo]

Excellent result and superb presentation. Congrats.

[orangehair]

kudos on your documentation - nice outcome with strip surgery

[Dr Blake Bloxham]

Great case, and clearly a good decision to recommend the FUT above more FUE. Glad to see it worked out very well for this patient!

[HairCenter]

Thank you everyone for your comments. I wish to make it clear that the result has nothing to do with finasteride as the patient was on finasteride for a full year before he ever set foot in our clinic. As you can see in the placement photos the majority of the grafts were placed in the first few centimeters of the hairline and temples with the mid-scalp receiving moderate surgical attention. The majority of the thickening of the mid-scalp is due to the PRP/ACell treatment.

 

Here is a video we finalized to show the result in 4K Ultra HD and the patient even mentions his finasteride usage and how he feels that his FUE procedure made little aesthetic improvement.

 

 

[T-TYPE]

unfortunately the strip scar is clearly visible in the thinned out zone which begs the question was strip a better choice here?

 

looks to me to have plenty of donor hair left adjacent to the thinning area from the previous HT. there are plenty of available grafts above his ears.

 

that area in the back which is thinned out is very small and taking from adjacent area would have actually made the thinning area more spread out and natural looking.

 

now he has a thinned out area with a visible strip scar in it.

[JON86]

Fantastic result from a fantastic doctor.

[ru5884111]

The majority of the thickening of the mid-scalp is due to the PRP/ACell treatment.

 

:rolleyes:

[HairCenter]

unfortunately the strip scar is clearly visible in the thinned out zone which begs the question was strip a better choice here?

 

looks to me to have plenty of donor hair left adjacent to the thinning area from the previous HT. there are plenty of available grafts above his ears.

 

that area in the back which is thinned out is very small and taking from adjacent area would have actually made the thinning area more spread out and natural looking.

 

now he has a thinned out area with a visible strip scar in it.

 

"Clearly" is subjective as some would say it is the demarcation itself that is visible rather than the scar and most would barely notice that if it were not pointed out by Dr. Cooley in the video. However, the patient feels that strip was clearly the better choice. What you refer to as a "very small" area that is thinned out is, in reality, no less than 40% of the entirety of the occipital region. I'm not talking about the safe donor zone, I'm talking about the entire back of the scalp which includes the lower portion of the unsafe crown region.

 

 

What you are referring to is called homogenization. Yes, of course there are more grafts to be taken with FUE but after the thinning that occurred we believe it is obvious why one would not want to purposely thin out the donor zone further.

[Dr Blake Bloxham]

Great video.

[HairCenter]

Thank you, Dr. Bloxham.

[JayLDD]

I also tend to think for this surgery an FUE to better homogenise the donor zone rather than leaving the scar in direct view due to a thinned donor zone would have been a smarter choice, however still a fantastic result overall.

[arussell]

Delacey I am not sure what you are asking in the question above "

Out of curiosity, what yield can one expect from an FUE procedure at Dr. Cooley's clinic?", if you are asking how large a procedure we are able to do with FUE there are many facets to the answer. It will depend on the native donor density first of all. We do Both FUSS and FUE. Our surgeries just like most clinics range in size. Dr. Cooley always uses ACELL in all surgeries regardless of the harvesting method. I would say our average FUSS is 2500-3000 and FUE average is 2000. If you mean the percentage of waste, that is much more subjective. Dr. Cooley uses the the WAW or some refer to it as the flat punch which has decreased waste significantly. We still place all grafts under a scope and trim excess tissue. This step also gives us the ability to segregate the grafts so Dr. Cooley definitively knows a one hair follicle from a two! I hope this addressed the question.

[makem307]

That's a brilliant result I am looking at getting a 2 small procedure to augment my transplant from 2014 where I had 1800 grafts via fue. To increase the density of my left temporal zone as I have a similar lack of density in the same section of my hairline. Though luckily more density behind.

[Mick50]

Whichever clinic did the first FUE on this patient did a terrible job, they should have extracted over a larger area to a avoid the extraction pattern he was left with.

[Dr. Alan Feller]

This presentation is an excellent example of why FUE should be used in limited numbers and in limited cases.

 

The photos Dr. Cooley shows of the donor area thinning is extremely common in FUE patients. In fact, Dr. Paul Rose recently gave a lecture and wrote an excellent article as to why even relatively small sessions of FUE can cause pathological thinnig out the donor area.

 

This is a case of excellent patient evaluation and management.

 

Well done Dr. Cooley and Staff.

 

Dr. Alan Feller

Great Neck, NY