2nd FUT or FUE?

[xtatic5]

I had FUT to lower my hairline 4 years ago and I'm thinking of going under the knife again for added density. Based on my surgeon's estimate at the time, I would need approx 800 more grafts to achieve "full" density.

 

I haven't been on the site in a long time: Is it still the prevailing opinion that once you've been scarred by FUT once, you might as well get FUT again?

 

Some factors affecting my decision:

 

Curly hair (+1 FUT)

Tight scalp (+1 FUE)

Recovery time (+1 FUE)

Scar Revision (+1 FUE)

 

I'm leaning toward FUE since it's a relatively small job (transection won't be significant) and I can get FUE into the scar simultaneously. My ultimate goal is to get off of concealers.

Edited July 17, 2017 by xtatic5

[mattj]

Are you needing density added to the area already worked on previously? I'm just curious if that's what the goal is.

 

Before your FUT procedure, did you do any scalp exercises to increase laxity? They are recommended for any FUT patient, they actually work and could eliminate your tight scalp as an issue if you were to choose FUT again.

 

Are you able to upload photos?

[xtatic5]

I am looking to add density to the previous work.

 

I did not do consistent scalp exercises prior to my last surgery.

 

How many grafts do you reckon I'd need to achieve "full" density (without concealers)? My first surgeon suggested 800. Dr. Erdogon suggested 2000-2500 in the hairline and 500-800 in the scar (based on photos). I find that very hard to believe considering 2500 grafts is a dense hairline by itself! I already have 2000 grafts in place...

[mattj]

Personally I think 800 grafts would not be enough for your hairline, but 2500 seems like a lot. 1500 - 2000 would be a figure to aim for, but I'm basing that on photos and even doctor recommendations can change once they see you in person.

 

Your donor density doesn't look to be very high and I think this is why your scar is showing as much as it is on your left side, where the scar is thinner. On the right side, the scar is obviously wider and it looks like the hair parts either side of it; with the hairs above it going upwards and those below it going downwards. Is that how it grows or did you style it that way for the photos?

 

I would say that an FUE procedure of no more than 2500 grafts in total could tackle your hairline density and scar. You'd have to be aware that with your donor density possibly being below average, it could be noticeably thinned out by FUE.

[mattj]

Also, it might be worth looking into scalp micropigmentation at some point down the road, as this can work wonders for covering scars.

 

This would be best approached after you've had your surgery, when you're pleased with your hairline density and have seen how well the scar was improved by the grafts. I say this because if you like to keep your hair at the length in the photos, I don't think SMP alone would tackle the scar. It would need actual hairs within it. But after that, if there is still some hairless scar tissue showing through, then SMP could help disguise it.

[xtatic5]

Mattj, I did part my hair to reveal the scar. Without parting, bits of the scar are visible at a guard 3 cut. I'd like to wear my hair at a 2 or, ideally, 1 guard.

 

I agree with your estimate of 1500 grafts at the hairline. I would want the increased density to start about .5cm in which is 20% less area than my original surgery.

 

I haven't been told that my donor density is low but I'm open to body hair FUE if necessary. This could also be a reason to do FUT again since it could result in a better scar. I have considered SMP but held off because I knew another surgery was inevitable.

[mattj]

I can tell you've done your reading about this subject.

 

A second FUT could potentially improve the scar, if done right. Your scalp laxity would also be very important to the outcome. This can't be overstated.

 

I'd be interested to hear what your shortlist of doctors say about your donor density. It appears slightly below average to me, but I'm not a doctor.

[Coach]

I had an FUT the first time, and an FUE the second time. I would go with FUE again, but you should talk to your doctor about what is best for you.

[Bill - Seemiller]

Xtatic,

 

In my opinion, though I know that you purposely combed your hair to show the scar, it looks like you could benefit from some scar revision in addition to a nominal amount of grafts in the hairline to soften it up a bit. I don't really think based on the pictures that you need more density as much as just a slight softer appearance in the hairline. I think 800 grafts would do just fine.

 

As for whether or not you should go the strip or FUE route, I think there are some pros and cons to both. For example, if you go to strip route, you may be able to improve the appearance of your scar just from the actual procedure itself while getting the grafts that you need for surgery. On the other hand, if the scar is not improved, you might want to go back for FUE to fill-in the scar so that its appearance is reduced. That's always an option. On the other hand, if you go the FUE route, you could always get the 800 grafts that you need for the procedure and then gets another 800 to 1000 grafts to fill in the scar right off the bat. Of course this will be more expensive for two reasons, one FUE is more expensive and two, you will be getting more grafts. That said, FUE is sometimes not as consistent in growth as strip and growth yield is often impacted when putting it into the scar.

 

So there are definitely something to think about regarding this case. That said, overall I think your hair looks great so you really probably don't have to get anything done. But as long as you select an outstanding surgeon, you should be in good shape.

 

Best wishes,

 

Bill

[Sean]

I think a second FUT will be good if you want to take a shot at reducing the scar. If your donor density is low, FUE may not be the best track imo. Be careful with body hair, there could be yield issues. I think for best viable grafts, a fut will be better. FUE extraction may be hit or miss while FUT you pretty much can get healthier grafts via slithering. This is because a surgeon is not extracting blind, they are getting grafts froma strip. Take a look at all your options and what you are comfortable with. Best of luck.

[xtatic5]

Thank you for the thoughtful comments. I really want my next surgery to be my last so FUE seems like the safer option in that regard. I'm not opposed to strip if laxity or donor density are issues.