What's better for the first surgery? FUE or FUT?

[Optimistic1]

Hello all

I am going to do my first ever hair transplant. Doctors I contacted with told me that I may need another surgery in the future.

Now I am confused whether better to get FUE or FUT surgery. Especially that I will need another one in the future. So, I do not want to have bad-looking donor area after the two surgeries.

[JayLDD]

Contrarian opinion, but the risks associated with FUT are significantly larger and have to be considered in the equation. Unless you're dealing with motorised or overly large punch tools (0.85mm or larger for Caucasians) you will virtually never see abnormal or disaster cases among top surgeons skilled at FUE megassessions, and more than acceptable results on average donors with up to 5000 grafts. Consistently on the other hand you will see FUT scarring and shock loss even with top surgeons where a month of hair growth does not cover the scar, which is clearly indented and visible.  Unless you're dealing with a situation of a well below average donor or NW6 where the donor looks depleted before even having been touched in surgery then the risks are far higher with FUT.  It's true that maybe 95% of FUT will achieve a lower magnitude of scarring than if they went with FUE and scarring will be close to pencil thin, but look at how many bad scars and shockloss occur with top surgeons and ask yourself if its worth it for the 19/20 who doesn't have that experience and effectively ruins their donor in a single procedure. 

There isn't a single shred of evidence that FUE makes a substantive impact on potential to have FUT in future either. The question that should be asked is whether or not you can achieve the results you are after long and short-term with FUE, if you're the rare patient that clearly can't (NW6 or well below average donor) then consider FUT.  Erdogan and Lorenzo consistently achieve successful donor management with graft numbers in the 5-7000 range, Vories doesn't as often get into this range but also has cases showing this. 

[Optimistic1]

Thanks for your detailed comment.

What do you mean with NW6?

Also, I am considering Dr. Ali Emre karadeniz. Do your recommend him? If not, who else you recommend in Turkey other than Erdogan who I cannot afford his surgery cost?

[JayLDD]

7 minutes ago, Optimistic1 said:

Thanks for your detailed comment.

What do you mean with NW6?

Also, I am considering Dr. Ali Emre karadeniz. Do your recommend him? If not, who else you recommend in Turkey other than Erdogan who I cannot afford his surgery cost?

NW6 as in norwood 6 on the Norwood scale, so issues with an extremely large balding area to cover and a smaller donor area. In my opinion you should keep saving if you cannot afford that pricing, Erdogan is definitely the cheapest top end surgeon globally. Bhatti does decent work for very low prices, but he's not at the same level and nor is karadeniz who has too many poor results and experiences in my opinion, and doesn't have the same consistency of strong posted results to look at recently.

Also if you cannot afford Erdogan, you're probably not going to afford FUT with a decent surgeon because they all charge above his prices.

Edited July 19, 2018 by JeanLDD

[Optimistic1]

What about Dr. Erkan Demirosy?

[JayLDD]

7 minutes ago, Optimistic1 said:

What about Dr. Erkan Demirosy?

Same situation, he definitely has plenty of good cases but too many bad experiences and poor results for my liking. Again the lack of consistent and  recent exposure of his results also is a red flag for me.

[Markee]

4 hours ago, JeanLDD said:

Contrarian opinion, but the risks associated with FUT are significantly larger and have to be considered in the equation. Unless you're dealing with motorised or overly large punch tools (0.85mm or larger for Caucasians) you will virtually never see abnormal or disaster cases among top surgeons skilled at FUE megassessions, and more than acceptable results on average donors with up to 5000 grafts. Consistently on the other hand you will see FUT scarring and shock loss even with top surgeons where a month of hair growth does not cover the scar, which is clearly indented and visible.  Unless you're dealing with a situation of a well below average donor or NW6 where the donor looks depleted before even having been touched in surgery then the risks are far higher with FUT.  It's true that maybe 95% of FUT will achieve a lower magnitude of scarring than if they went with FUE and scarring will be close to pencil thin, but look at how many bad scars and shockloss occur with top surgeons and ask yourself if its worth it for the 19/20 who doesn't have that experience and effectively ruins their donor in a single procedure. 

There isn't a single shred of evidence that FUE makes a substantive impact on potential to have FUT in future either. The question that should be asked is whether or not you can achieve the results you are after long and short-term with FUE, if you're the rare patient that clearly can't (NW6 or well below average donor) then consider FUT.  Erdogan and Lorenzo consistently achieve successful donor management with graft numbers in the 5-7000 range, Vories doesn't as often get into this range but also has cases showing this. 

JeanLDD     Nice post hope I never in a position where I have to get a FUT  

[TrixGlendevon]

16 hours ago, JeanLDD said:

Contrarian opinion, but the risks associated with FUT are significantly larger and have to be considered in the equation. Unless you're dealing with motorised or overly large punch tools (0.85mm or larger for Caucasians) you will virtually never see abnormal or disaster cases among top surgeons skilled at FUE megassessions, and more than acceptable results on average donors with up to 5000 grafts. Consistently on the other hand you will see FUT scarring and shock loss even with top surgeons where a month of hair growth does not cover the scar, which is clearly indented and visible.  Unless you're dealing with a situation of a well below average donor or NW6 where the donor looks depleted before even having been touched in surgery then the risks are far higher with FUT.  It's true that maybe 95% of FUT will achieve a lower magnitude of scarring than if they went with FUE and scarring will be close to pencil thin, but look at how many bad scars and shockloss occur with top surgeons and ask yourself if its worth it for the 19/20 who doesn't have that experience and effectively ruins their donor in a single procedure. 

There isn't a single shred of evidence that FUE makes a substantive impact on potential to have FUT in future either. The question that should be asked is whether or not you can achieve the results you are after long and short-term with FUE, if you're the rare patient that clearly can't (NW6 or well below average donor) then consider FUT.  Erdogan and Lorenzo consistently achieve successful donor management with graft numbers in the 5-7000 range, Vories doesn't as often get into this range but also has cases showing this. 

To counter Jean's post - shockloss does grow back and you can easily FUE into the scar at a later date if you want to shave the hair down. Having a thin scar on the back of your head doesn't have to be the death penalty it was years ago. Even if the scar does stretch, then you can have scar revision. If you go for a like-for-like surgeon i.e. comparing a top FUT surgeon with a comparably top FUE one, there won't be much difference in the side effects except that 1) the transection rate is lower for FUT meaning more and healthier grafts from the extraction in that particular procedure and 2) more grafts over the lifetime of the donor i.e. you can go back for surgery more times. You can also ensure you get grafts only from the "sweet spot" with FUT whereas that is much more difficult for FUE if you want any kind of yield. This means less chance of the hairs falling out in the future.

I think one of the issues in this debate is that people will compare a poor FUT surgeon with a great FUE surgeon or, less rarely, vice versa and state that as a win for their preferred procedure of choice. LIke-for-like in terms of surgeon skill, I do not think there is a right/wrong answer just a different set of pros and cons.

I do agree that Erdogan is world class and if you can't afford him in Turkey, and you're set on FUE, I'd keep saving. Pay cheap, pay twice. You'll only be going to him for the repair job anyway. He is cheaper than FUT procedures in other countries from very good/top surgeons with great results.

[BHRClinic]

Most of surgeries done today are FUE. That said, not every patient is a FUE candidate or can get a total coverage with FUE alone. If you have a big baldness (let's say NW 6-7), probably FUE will not be enough to cover all or most part of it, unless you have great donor characteristics (density, calibre, hair-count, etc.).

So if a patient want to maximize his donor capacity, maybe starting by FUT is a good option, and then do 1-2 FUE procedures in the future.

Best wishes,