#BAM REVISING a POOR-DENSITY Transplant: 2633 FUT grafts Carlos K. Wesley, M.D. (NYC
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Billena, in Results Posted by Leading Hair Restoration Clinics
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By Dr Blake Bloxham · Posted
Beautiful work, Dr. Cooley. The patient must be thrilled. Excellent presentation too. I love the "comb-through" video. -
By Dr Blake Bloxham · Posted
Hi Phil, I always try to make the time -- though I will admit that I am falling behind on answering private messages, and I do apologize to anyone waiting for a reply! I truly like being a clinic that can offer patients both FUT and FUE. And not just in name only. While I think I have made my reputation with FUT and I am a very vocal proponent of it, I perform FUE every single week. We have an OR specifically for FUE; we have a staff cross-trained specifically for FUE (who have been assisting in the FUE process since 2002); and I feel very blessed to have learned manual FUE from my partner, Dr. Feller, who was one of the first three to perform the procedure in North America (the others being Dr. C in Atlanta and Dr. Jones in Canada) and someone who has multiple patients and publications in early FUE development. So, long story short, I think we do have the ability to recommend and offer patients both. I do not think there is a strict, binary decision as to when a patient is a candidate for FUT versus FUE. From a strict mathematical and scientific standpoint, I absolutely do believe there are instances where one should be utilized to the exclusion of another. And in these situations, it will absolutely be my recommendation to use one versus the other. In the real world, however, patients have different long-term goals, different lifestyles, and sometimes what may be the best technique on paper is not the best one in practice. So I do my best to come up with plans and approaches using both methods when patients request it or ask for one above the other. When they simply ask for my opinion, I try to always be objective as described above. Here are some generalizations about when I think you should do one above the other or who is a good candidate for FUT over FUE: Start with FUT: -Young patients with uncertain futures and all but guaranteed progression -People with advanced hair loss -People with limited donor (as long as the limitation is not the density; in patients with very low densities, I actually usually recommend conservative FUE) -Patients who need critical hairline work and cannot risk yield (print models, film actors, etc) - Patients who are likely to want to do more surgeries up the road -Patients with hair types that I do not believe will do well with FUE: very fine, light hair (fragile follicles), certain ethnic groups, etc -Patients with a lot of laxity or very "stretchy" or "mushy" skin -- which I believe will either deform or distort and just not let us accurately score the grafts -Patients who want to do the most possible in a single sitting Start with FUE: -Patients with obviously stable loss only requiring a small amount -Patients who must keep the sides very short (certain military guys; certain actors with crazy film/studio contracts; etc); however, you cannot undersell the scarring to these individuals because it is not a scar-less procedure -Patients with very tight scalps or very low density where the "scarring to graft number" ratio is just not good enough with FUT (IE: taking a 30+cm strip and only getting out 1,200 grafts because the scalp is so tight and the strip was thin or the density was so low) - Patients happy with their prior strip scar who just need a little more work -Patients with prior strips who cannot undergo any more -Patients requiring less than 1,500 grafts (which I now still split up into two days as I like doing everything manual and staying very involved with FUE procedures) - Patients who are not 100% ready to commit to transplants but want to "test the waters" a bit first (again, we need to be careful not to oversell anything to these patients) Surely I am forgetting a few here, and this list is not all inclusive; however, good generalizations. In patients who are not concerned with the scar or want to get as much as possible (the majority of patients) or just want to go with what I recommend, FUT is typically a great starting point. I also offer a "modified" approach to FUT where I break up the strip into smaller 2cm pieces, which are somewhat staggered and broken up. It allows patients to go a little shorter on the sides and the scarring, if it is seen, looks more like trauma than a telltale surgical scar, so it gives people a little more wiggle room up the road. I have probably shared a few of these cases on here before, and I will share more in the future. -
By Dr Blake Bloxham · Posted
Hi Gasthoerer, Thank you for the kind words. Glad the point about hairlines makes sense and is resonating with the community. -
By Dr Blake Bloxham · Posted
Hi jj, Good to hear from you. Thank you for the kind words. The patient's hair loss is pretty stable; I actually saw him a few times for consultation (good time gaps between) and I did not note any changes. So I do not believe there will be aggressive thinning in the back, and his bridge looks great. However, he does have a small, isolated spot in the crown and has expressed interest in getting this filled. So I do not believe this will be his last transplant. However, you never can be too certain with androgenic alopecia. I have seen "stable" patients who look great suddenly thin and need every graft they can get, and I have seen seemly "unstable" patients go years before changing at all. It is very unpredictable, so it always helps to hedge our bets a bit and leave the absolute most available donor for surgeries up the road. If he only needed 1,500 grafts or so, I would have felt comfortable starting with FUE because this level of harvesting (when spread appropriately) typically allows us to stay within the safe donor and does not impede the future too much. For the amount we were doing, however, I felt that FUT was the best bet at not only delivering the results, but also not putting us in a potentially bad situation if he did start thinning more up the road and we wanted to do more surgery. -
By Dr Blake Bloxham · Posted
Thanks, Greg. While healing is physiology-dependent and does absolutely vary between patients, I think some of the "fears" of FUT scars we see online are a bit overblown. With good technique and ethical harvests, the VAST majority of patients heal up with a fine line in the back that is easily hidden. I always tell patients that it will be anywhere from a "pencil line" that is hard to even appreciate if you are a perfect healer, to a "marker line" (1-2 mm of "stretch") if you are a bit of a "stretcher"; anything within this range is perfectly normal and can be easily concealed even with a shorter, cropped hair cut (typically a number 3 on the buzzer). And the trade-off for the scar is fantastic; thousands of the best quality grafts, minimal damage and maximum preservation of the donor, and the ability to do more up the road. While FUT is not for everyone and I totally get that, I think many patients are best served by doing an FUT first and then switching to FUE down the road and I do encourage everyone to tune out some of the noise (which I myself have been guilty of making from time to time!) and really objectively research both techniques from the beginning.
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