FUE vs FUT - a pre-mortem for prospective hindsight

[bismarck]

The issue is scar vs yield/ease of repeat procedures. There are no absolute answers. Ben Franklin and Paul O'Neill, two of the greatest decision makers of all time, were fans of making lists and assigning point values to those lists, so I will try something similar here to clarify my thoughts. 

PRO FUT:
-Is the yield that much different? Not massively with a good procedure, but there is a difference. Better surgeons less so, but with pictures posted online from docs that do both, it appears their FUT results are superior. Comparing across the best, on average it seems like Konior can do as much with 2K grafts FUT as De Freitas can do with 2.8K grafts FUE. [8/10 importance]

-Are repeat procedures more difficult after FUE? Yes. [9/10 importance]

PRO FUE:
-No linear scar, which leaves me an exit strategy when I get old and bald, which I presume will ultimately happen for me based on my family history. [10/10 importance]

Thinking in images of bad scenarios can also be helpful. The so-called 'pre-mortem' that allows for prospective hindsight.

FUT pre-mortem:

-The fear with strip is that I would be able to redistribute my hair to a point, but then I would be stuck once the donor ran out. A sort of follicular musical chairs. As someone said previously -- right now, in malls around the world there are thousands of men walking around with tufts of hair in front, bald crowns, and sad expressions on their faces, wishing they could shave down but caught forever in transplant purgatory.

FUE pre-mortem:

-Poor yield outcome. Scarring up your donor but the recipient area also not taking. The second attached image is a 2600 FUE case by the esteemed Freitas with massive shock loss. Unfortunately no follow up after this. Hopefully he recovered, but no one knows. Horrifying in its own right, though he still probably has an exit strategy.

Future projection:

-Perhaps I have 20 years to baldness. With FUE, I can perhaps spend 10 of those years with great hair, then a slow decline through my early 50s ending with a shaved head. With FUT, perhaps 15-20 of those years with great hair, ending with diffuse thinning in my 60s with no option for shaving.

Summary:

Negative outcomes with both are less likely, but it is never going to be zero percent. Which has the higher possibility of occurring? This is personal.

For me, my dad has diffuse thinning post multiple strips (72), but his hair loss was worse than mine at a similar age. I am a Norwood 2.5 at 38 because of Avodart. This will probably change when I discontinue the medication, which ultimately I will have to do because I have been having progressive issues with ED/libido. After that, I will probably return to my genetic baseline. So the FUT pre-mortem probably awaits. Perhaps I can stay on Avodart or Propecia till I die, but there is a good chance I will not.

Will I care as much about my appearance in my 60s as I do now? I don't know, but I certainly care as much about my appearance now as I did in my early 20s. I am still single and without kids, perhaps these major life events will also change my perspective, but talking with friends it seems they are very aware of what they look like.

Could you have poor yield with either approach? Yes, but less likely with strip. Could you have an unsightly scar with either approach? Yes, but far less likely with FUE.

Nerve racking how much uncertainty there is in the field.

 

 

Edited August 29, 2018 by bismarck

[TrixGlendevon]

Sums up perfectly my opinion on the matter too. I will opt for FUT though and then get some grafts put into the linear scar. I am also researching MSP to put into it. I have seen very good results of this where the hair transplantee can shave their hair to a number 1 (or less) and the scar is still hard to see.