FUE makes repeat procedures more difficult as compared to strip

[bismarck]

This is a statement I have heard from surgeons due to the diffuse scar tissue that occurs after the procedure. This would obviously reduce lifetime yield, but I wanted to hear from people who've actually had the surgery.

Also, is there any data behind this? 

 

[LonelyGraft]

Great questions. I’ve been wondering the same. There is absolutely no doubt fue creates more scarring overall but does it really make having a strip procedure down the line more difficult? This may just be information/misinformation spewed by dr feller and his associate dr bloxham without much data to back it up. Sure, he may have some anecdotal evidence but to me that doesn’t say much. What makes it even more questionable is that they perform “repair” procedures on people that have had bad results from fue, so couldn’t they at least present what they do differently for these patients that have previous fue scarring since it’s so difficult to do fuss after fue?

[bismarck]

Blake has stated this in the past, and Diep also said something similar. Other docs that favor FUE seem to focus on yield, hard to get a concrete answer from them about repeat procedures. Having the ability to do one fewer repeat procedure would obviously matter far more than a 5% difference in yield.

I haven't seen much commented about it from other docs. Would like to hear from some of the European folks on this. I will update this thread if I come across more info on the subject, even if its the anecdotal experience of individual surgeons. Just trying to get some sort of consensus on the subject.

[JohnCasper]

I’ve read many posts through the years of patients having FUE after having strip surgery to cover the linear scar or other reasons.  Don’t recall many opting for strip after FUE.  I’m sure they are out there.  My FUE results were excellent on both surgeries. I’d be interested to hear from others who went with strip surgery after starting with FUE.

[bismarck]

Exactly. Also, I would presume that a bad scar would limit repeat procedures due to the need to keep the scar hidden. Would this be more likely than FUE limitations from scar tissue/density depletion?

The cop out answer, and unfortunately probably the most accurate one, is that it depends on the patient. I tend to scar well so I don't think I would have FUT issues. But I also suspect that I won't be on Avodart for the rest of my life. It would be nice to have the comfort that when I put the pills away and my genetic baldness comes through, I'll have some flexibility as far as buzzing it down.

The question is, where will the hairline drawn in the sand be at that point? Presumably would be better with strip, but how much better? Enough to avoid shaving? And I'm back at the cop out answer.

Good grief.

[Speegs]

FUT is still the most responsible manner of maximizing grafts for the long term.

Reputable doctors that perform both FUT and FUE will often favor FUT for large cases, and gameplan long term to maximize grafts via FUT and then turn to FUE once FUT is no longer an option.

If you have significant hair loss, it is my opinion as well as the opinion of many distinguished physicians far more qualified than a patient educator such as myself, that FUT is how you begin your journey.

It simply has your long-term interests in mind better than FUE does.

FUE is for touch-ups, small to moderate cases, or if FUT simply is not physiologically possible because of past surgeries or a lack of natural scalp laxity.

It's why you should always go to a surgeon that can do both and has a track record of performing well with either, these are the physicians that have the nuanced approach to every case that you want from your doctor.

 

Edited September 5, 2018 by Speegs

[JayLDD]

1 hour ago, Speegs said:

FUT is still the most responsible manner of maximizing grafts for the long term.

Reputable doctors that perform both FUT and FUE will often favor FUT for large cases, and gameplan long term to maximize grafts via FUT and then turn to FUE once FUT is no longer an option.

If you have significant hair loss, it is my opinion as well as the opinion of many distinguished physicians far more qualified than a patient educator such as myself, that FUT is how you begin your journey.

It simply has your long-term interests in mind better than FUE does.

FUE is for touch-ups, small to moderate cases, or if FUT simply is not physiologically possible because of past surgeries or a lack of natural scalp laxity.

It's why you should always go to a surgeon that can do both and has a track record of performing well with either, these are the physicians that have the nuanced approach to every case that you want from your doctor.

 

The idea of starting strip and then moving to FUE after running into laxity issues is a somewhat a moot point when I have seen only a minuscule % of posters go over the 6000 graft mark to begin with. Most people don't desire or require graft numbers and results that can only be achieved with strip. The vast majority are hitting their goals with numbers below this and aren't looking for perfection or coverage in every last gap, so if the worry of scarring and wearing the donor short is any issue to you, why start strip? Take a look for yourself how many people ever in their lives go above the range FUE can provide. Few and far between, even in hair transplant circles they are hard to find.

A lot of this debate is in the realm of theoretical when real world needs on this forum don't match up. Yes we can all understand that microscopic dissection of grafts is going to be more efficient than blind extraction, and that strip will for the most part cause a lower magnitude of scarring and allow maximum usage of the donor, but if 99% of people on a hair transplant forum aren't EVER requiring graft numbers above 6000 for the results they desire, its hard to see the who FUT appeals to. Even for those that are high norwood rarely do I see a NW6 demand full coverage at all costs that would necessitate FUT, they typically end up opting for conservative graft numbers and an approach that could have been easily achieved by FUE in terms of graft numbers.

The other big consideration is that ultimately FUT is a wildcard procedure in comparison to FUE. Yes you may be the 19/20 who goes to a top surgeon and have an FUT scar that is barely visible even with a tight buzzcut in which case it appears "gold standard" having also done minimal damage to the donor compared to FUE, but what about if you're the guy that ends up going to Rahal, HnW, Gabel etc and still ends up looking butchered with a scar that shows at a month of growth and odd looking angulation separating either side? You see it on a regular basis too. It's the more "responsible" method until you go to a top surgeon and still get awful scarring.

Those are the two big questions for choosing, do you need to do FUT to achieve your desired hairline, coverage and density? (for 99% of people on hair-transplant forums the answer is a flat, indisputable no, especially when surgeons like Lorenzo, Freitas and Erdogan FOR example do better work than the vast majority of FUT surgeons consistently) Secondly would you be prepared to have a scar on the lower end of acceptability that wouldn't allow for any sort of short hair cut? 

On top of all that Bismarcks question ought to be considered too. Unfortunately no good info on it.

[Speegs]

27 minutes ago, JeanLDD said:

The idea of starting strip and then moving to FUE after running into laxity issues is a somewhat a moot point when I have seen only a minuscule % of posters go over the 6000 graft mark to begin with. Most people don't desire or require graft numbers and results that can only be achieved with strip. The vast majority are hitting their goals with numbers below this and aren't looking for perfection or coverage in every last gap, so if the worry of scarring and wearing the donor short is any issue to you, why start strip? Take a look for yourself how many people ever in their lives go above the range FUE can provide. Few and far between, even in hair transplant circles they are hard to find.

A lot of this debate is in the realm of theoretical when real world needs on this forum don't match up. Yes we can all understand that microscopic dissection of grafts is going to be more efficient than blind extraction, and that strip will for the most part cause a lower magnitude of scarring and allow maximum usage of the donor, but if 99% of people on a hair transplant forum aren't EVER requiring graft numbers above 6000 for the results they desire, its hard to see the who FUT appeals to. Even for those that are high norwood rarely do I see a NW6 demand full coverage at all costs that would necessitate FUT, they typically end up opting for conservative graft numbers and an approach that could have been easily achieved by FUE in terms of graft numbers.

The other big consideration is that ultimately FUT is a wildcard procedure in comparison to FUE. Yes you may be the 19/20 who goes to a top surgeon and have an FUT scar that is barely visible even with a tight buzzcut in which case it appears "gold standard" having also done minimal damage to the donor compared to FUE, but what about if you're the guy that ends up going to Rahal, HnW, Gabel etc and still ends up looking butchered with a scar that shows at a month of growth and odd looking angulation separating either side? You see it on a regular basis too. It's the more "responsible" method until you go to a top surgeon and still get awful scarring.

Those are the two big questions for choosing, do you need to do FUT to achieve your desired hairline, coverage and density? (for 99% of people on hair-transplant forums the answer is a flat, indisputable no, especially when surgeons like Lorenzo, Freitas and Erdogan FOR example do better work than the vast majority of FUT surgeons consistently) Secondly would you be prepared to have a scar on the lower end of acceptability that wouldn't allow for any sort of short hair cut? 

On top of all that Bismarcks question ought to be considered too. Unfortunately no good info on it.

12

Simply untrue.

There will be scarring from surgery, the idea that 6000 grafts of FUE will be scarless is ridiculous, and 6k scars are just as cosmetically impactful as one linear scar, potentially more so, despite the marketing as otherwise.

Also, FUE benefits greatly being done by a practice that also does FUT because the state-of-the-art microscopes are in-house to check and prepare the grafts meticulously, often FUE only practices don't invest in these microscopes and the result can be that grafts aren't given every possible advantage to survive and thrive.

I was a Norwood 3A, I have fine hair and fair skin requiring more grafts than generally proposed to create a cosmetically impactful density, in the ballpark of 7k in the frontal third.

All these grafts were harvested via FUT, going forward I'd probably require FUE, since I've done 3 FUT procedures, and my single linear scar is a non-issue, no barber or stylist has found it without prompting.

 

 

 

 

 

[JayLDD]

2 hours ago, Speegs said:

Simply untrue.

There will be scarring from surgery, the idea that 6000 grafts of FUE will be scarless is ridiculous, and 6k scars are just as cosmetically impactful as one linear scar, potentially more so, despite the marketing as otherwise.

Also, FUE benefits greatly being done by a practice that also does FUT because the state-of-the-art microscopes are in-house to check and prepare the grafts meticulously, often FUE only practices don't invest in these microscopes and the result can be that grafts aren't given every possible advantage to survive and thrive.

I was a Norwood 3A, I have fine hair and fair skin requiring more grafts than generally proposed to create a cosmetically impactful density, in the ballpark of 7k in the frontal third.

All these grafts were harvested via FUT, going forward I'd probably require FUE, since I've done 3 FUT procedures, and my single linear scar is a non-issue, no barber or stylist has found it without prompting.

 

 

 

 

 

I never said 6000 FUE grafts would be scarless or even close to that, difference is that that I've never seen a single FUE result from a top surgeon (and I've seen thousands, including hundreds over the 5000 total graft mark) where a person has donor scarring that renders any guard of buzzcut impossible, or with scarring visible past a month of growth, or permanent shock loss around the scar makes FUE difficult in future. I've seen plenty of awful scars from top FUT surgeons like Rahal and HnW with issues like these. It's the extent of the cosmetic risk.  No would suggest that FUE is scarless, but it doesn't carry the same risk of a butchered donor area that FUT does when comparing results by top surgeons. I might buzz down to a grade 2-3 in the next few months so will see how it looks after 6200 FUE grafts. Even 15 days after the second procedure scarring was barely noticeable, and thats without a decent amount of time to heal properly either. I've seen plenty of others at this graft level for whom its virtually undetectable even with a tight buzz. 

Understand your point for personal circumstances, however it isn't the norm that people require or want 7k grafts in the frontal third. In fact I've never seen anyone else do the same for a NW3A. As a generalisation most people don't demand or require that many grafts for their goals in an entire lifetime, nor do they quite frankly have the desire to go through 3 procedures and spend that much money on cosmetic surgery. Also the fact that your scar turned out well doesn't mean much for the 2-5% for whom it doesn't. I acknowledge that if you get the average scar from Konior, HnW etc you'd be better off than having gone FUE, but not everyone is lucky enough for average.  Also agree that use of microscopes in FUE is beneficial and a worthwhile selection criteria.

But ultimately saying its the "responsible" approach or only option for high norwoods  when there are a huge number of people getting FUE megassessions taking them from NW4-5 to what is visible as a full head of hair is delusional.  Of course people like in your circumstances might benefit from FUT, but you were lucky enough to not have bad scarring, and it isn't the norm (or even a 1%) that it takes 7k grafts for the frontal third result to satisfy them. 

Edited September 5, 2018 by JeanLDD

[Speegs]

18 minutes ago, JeanLDD said:

I never said 6000 FUE grafts would be scarless or even close to that, difference is that that I've never seen a single FUE result from a top surgeon (and I've seen thousands, including hundreds over the 5000 total graft mark) where a person has donor scarring that renders any guard of buzzcut impossible, or with scarring visible past a month of growth, or permanent shock loss around the scar makes FUE difficult in future. I've seen plenty of awful scars from top FUT surgeons like Rahal and HnW with issues like these. It's the extent of the cosmetic risk.  No would suggest that FUE is scarless, but it doesn't carry the same risk of a butchered donor area that FUT does when comparing results by top surgeons. I might buzz down to a grade 2-3 in the next few months so will see how it looks after 6200 FUE grafts. Even 15 days after the second procedure scarring was barely noticeable, and thats without a decent amount of time to heal properly either. I've seen plenty of others at this graft level for whom its virtually undetectable even with a tight buzz. 

Understand your point for personal circumstances, however it isn't the norm that people require or want 7k grafts in the frontal third. In fact I've never seen anyone else do the same for a NW3A. As a generalisation most people don't demand or require that many grafts for their goals in an entire lifetime, nor do they quite frankly have the desire to go through 3 procedures and spend that much money on cosmetic surgery. Also the fact that your scar turned out well doesn't mean much for the 2-5% for whom it doesn't. I acknowledge that if you get the average scar from Konior, HnW etc you'd be better off than having gone FUE, but not everyone is lucky enough for average.  Also agree that use of microscopes in FUE is beneficial and a worthwhile selection criteria.

But ultimately saying its the "responsible" approach or only option for high norwoods  when there are a huge number of people getting FUE megassessions taking them from NW4-5 to what is visible as a full head of hair is delusional.  Of course people like in your circumstances might benefit from FUT, but you were lucky enough to not have bad scarring, and it isn't the norm (or even a 1%) that it takes 7k grafts for the frontal third result to satisfy them. 

If your goal is a buzzed or cropped look and you have 6000 scars on the back of your head, that will not be invisible.

[JayLDD]

9 minutes ago, Speegs said:

If your goal is a buzzed or cropped look and you have 6000 scars on the back of your head, that will not be invisible.

If you respond to someones comment, try to at least respond to something they said, rather than making something up that had nothing to do with the comment to make them look bad or pretend to yourself you won the argument.

It will not be invisible, but it will be less cosmetically significant than a strip scar, and 5% give or take going to top strip surgeons will not be able to buzz or have a cropped look period. That isn't the case for FUE without going into graft ranges 99% of patients never require or want.

[bismarck]

6 minutes ago, Speegs said:

If your goal is a buzzed or cropped look and you have 6000 scars on the back of your head, that will not be invisible.

I wasn't sure about this so I did a quick search through the forums. Lorenzo's higher count patients don't look half bad with buzz cuts.

I think we have trained our eyes spending so much time on these forums to look for the tell tale holes of prior FUE. But I don't think there's anyone that misses a strip.

 

[Speegs]

1 minute ago, JeanLDD said:

If you respond to someones comment, try to at least respond to something they said, rather than making something up that had nothing to do with the comment to make them look bad or pretend to yourself you won the argument.

It will not be invisible, but it will be less cosmetically significant than a strip scar, and 5% give or take going to top strip surgeons will not be able to buzz or have a cropped look period. That isn't the case for FUE without going into graft ranges 99% of patients never require or want.

Your churlish demeanor and bad temper won't validate your posts, you haven't learned that yet I see.

Surgery carries inherent risk to it, that's why you seek accomplished physicians to mitigate the chance of complications, but complications can arise from patient physiology regardless of a surgeon's skill, which is why scarring can occasionally happen even after expert care.

[Speegs]

2 minutes ago, bismarck said:

I wasn't sure about this so I did a quick search through the forums. Lorenzo's higher count patients don't look half bad with buzz cuts.

I think we have trained our eyes spending so much time on these forums to look for the tell tale holes of prior FUE. But I don't think there's anyone that misses a strip.

 

Outside of hair transplant veterans, the general public doesn't fixate on your scars no matter how they came to pass.

If the average joe caught site of a pencil line scar on your head, which is unlikely, they'd just think you had a scar from something in life.

[JayLDD]

7 minutes ago, Speegs said:

Your churlish demeanor and bad temper won't validate your posts, you haven't learned that yet I see.

Surgery carries inherent risk to it, that's why you seek accomplished physicians to mitigate the chance of complications, but complications can arise from patient physiology regardless of a surgeon's skill, which is why scarring can occasionally happen even after expert care.

It's an apples to oranges comparison, FUT and FUE are two different animals when it comes to risk because they are two fundamentally different processes. Its not an argument to just throw your hands up and say "all surgery has risk". 

And a hint, I only get enjoyment from instances where people complain about my "temper" or demeanor, typically it occurs when people figure out their argument is flimsy so have to reach for other methods to save face.

Not that in this case its a temper anyway, in general I think your posts are helpful and worthwhile so I have nothing against you, its just the tone I enjoy writing in if I'm arguing a point that doesn't seem to be getting across. I do think patients should consider and research both procedures. 

Edited September 5, 2018 by JeanLDD

[Speegs]

2 minutes ago, JeanLDD said:

It's an apples to oranges comparison, FUT and FUE are two different animals when it comes to risk because they are two fundamentally different processes. Its not an argument to just throw your hands up and say "all surgery has risk". 

And a hint, I only get enjoyment from instances where people complain about my "temper" or demeanor, typically it occurs when people figure out their argument is flimsy so have to reach for other methods to save face.

Not that in this case its a temper anyway, in general I think your posts are helpful and worthwhile so I have nothing against you, its just the tone I enjoy writing in if I'm arguing a point that doesn't seem to be getting across. I do think patients should consider and research both procedures. 

I don't have any desire to argue.

Edited September 5, 2018 by Speegs

[JayLDD]

Just now, Speegs said:

So you're a self-admitted internet troll with no value to add to this community.

Thanks for spelling that out for the moderators.

Again, you clearly didn't read what I wrote and decided to make something up. Having a "churlish" demeanor doesn't make me a troll when clearly on this argument I'm the one being discerning and pointing the facts on the matter, rather than resorting to fallacies and strawmans of what someone else is saying.  

Calling people who back their arguments with facts that you can verify (like looking at high graft count Lorenzo and Erdogan cases) trolls despite not bothering to verify them yourself seems somewhat hypocritical also.

[Speegs]

4 minutes ago, JeanLDD said:

Again, you clearly didn't read what I wrote and decided to make something up. Having a "churlish" demeanor doesn't make me a troll when clearly on this argument I'm the one being discerning and pointing the facts on the matter, rather than resorting to fallacies and strawmans of what someone else is saying.  

Calling people who back their arguments with facts that you can verify (like looking at high graft count Lorenzo and Erdogan cases) trolls despite not bothering to verify them yourself seems somewhat hypocritical also.

Your pride gets you in trouble, you need to grow up quite a bit.

This is a platform for civil discussion not kneejerk emotive ranting, you have been given plenty of leash room for quite a while and it appears that has been counterproductive to letting you wise up.

You're no martyr for free speech, just an internet troll.

Edited September 5, 2018 by Speegs

[JayLDD]

Just now, Speegs said:

Your pride gets you in trouble, you need to grow up quite a bit.

This is a platform for civil discussion not kneejerk emotive ranting, you have been given plenty of leash room for quite a while and it appears that has been counterproductive to letting you wise up.

You're no martyr, just an internet troll.

I think anyone looking at the discussion would have a different view of who is being emotional and uncivil here but I'm happy not to respond to you.

[Speegs]

Just now, JeanLDD said:

I think anyone looking at the discussion would have a different view of who is being emotional and uncivil here but I'm happy not to respond to you.

I think most people here would be happy if you did not respond to them. 

[bismarck]

Man, this thread got so hijacked it might as well have flown into the World Trade Center. Let's try to stay on topic.

[jjsrader]

Still; good points are being made on both sides.  Let it continue if it must.