Does FUE damage potential for future procedures?

[mephesto]

Does getting FUE damage the ability to harvest the maximum amount of grafts in the future?

I've read the claim that FUT preserves the donor zone while FUE causes fibrosis around the donor areas -- making it harder to harvest for future procedures.

Is there any truth to that?

Edited April 10, 2019 by mephesto

[Melvin- Admin]

FUE does make it more difficult, but not impossible. If you plan on maximizing your donor always opt for strip first. That said, if you’ve already had FUE you can still have a strip. It will just make it more difficult for the cutters dissecting the strip.

[mephesto]

2 hours ago, Melvin-Moderator said:

FUE does make it more difficult, but not impossible. If you plan on maximizing your donor always opt for strip first. That said, if you’ve already had FUE you can still have a strip. It will just make it more difficult for the cutters dissecting the strip.

Thanks Melvin. Do you know if there's a general rule of how much less grafts you can get with FUE vs FUT?

[Melvin- Admin]

1 hour ago, mephesto said:

Thanks Melvin. Do you know if there's a general rule of how much less grafts you can get with FUE vs FUT?

It really depends, some individuals may be able to get more through FUE than FUT and vice versa. However, both procedures combined can get about an extra 2,000 grafts, as opposed to separately.

[Sean]

It sure can.  Outcome is worse if bigger punches are used to extract.  Makes it difficult during FUT to “slither” tissue if impacted area is extracted via strip later.  Lots of things to think about.  There are a lot of folks that will be ready to take advantage of the situation. Best is to think it through, if planning strip in the future, it is probably best to get strip first then fue later.  Best of luck.  Hope your journey is pleasant.  

[mephesto]

7 hours ago, Sean said:

It sure can.  Outcome is worse if bigger punches are used to extract.  Makes it difficult during FUT to “slither” tissue if impacted area is extracted via strip later.  Lots of things to think about.  There are a lot of folks that will be ready to take advantage of the situation. Best is to think it through, if planning strip in the future, it is probably best to get strip first then fue later.  Best of luck.  Hope your journey is pleasant.  

But the grafts can still be extracted after FUE via strip right? I was told by a leading surgeon that does both FUE and FUT that I could utilize future procedures with strip if I chose FUE first.

[Dr Blake Bloxham]

15 minutes ago, mephesto said:

But the grafts can still be extracted after FUE via strip right? I was told by a leading surgeon that does both FUE and FUT that I could utilize future procedures with strip if I chose FUE first.

Good replies from Melvin and Sean. 

Yes, you can remove grafts via FUT after having an FUE. The issue is not so much getting the grafts out of the strip. As Sean stated, it can make dissecting more difficult but a trained FUT staff should have no problem with this; the issue with doing FUT after FUE is simply that you will get a lot fewer grafts out of the strip. 

Let's say you have a virgin density of 80 graft/cm^2 in the donor region. If I take a strip of 30cm x 1 cm, I will obtain approximately 2,400 grafts (remember that this is just a simple example and not precisely reflective of nature). Now let's stay you had an FUE first and a responsible doctor took around 25% of the grafts throughout the area which will be strip harvested later on. This means your density now dropped from 80 grafts/cm^2 to 60 grafts/cm^2 -- because in FUE you have a drop in grafts without a change in surface area; and keep in mind that this would be a responsible harvest. So if we now took a 30cm x 1cm strip after the FUE harvest, you would only yield 1,800 grafts with the same incision line scar (IE damage in the donor). 

The other issue would be if the first doctor was not responsible with the FUE  harvest. When this happens, the yield from the strip becomes very low and there may be issues with covering the incision line because the donor has been significantly over-harvested. 

The beauty of strip is that you remove both grafts and surface area in one attempt, so you do not reduce the global density of the donor. This is what allows you to do multiple strip procedures with a minimal amount of scarring and then still do good FUE harvesting from all around the incision line (assuming you are not going to be an extremely high NW patient). It is typically best to do it this way -- FUT and then FUE -- if you are looking to do a combination of both. You absolutely can start with FUE, but just make sure you are not harvesting too aggressively and reducing the benefits of a potential strip up the road. 

Hope this helps. Best of luck with your decision. 

Dr Bloxham

[Al - Moderator]

The real potential problem and what you need to be aware may come later. Lets say you want FUE so you can buzz the sides and back without worrying about a linear strip scar, but you also think you will end up at a high NW level. You decide to go with FUE first with the idea that if it gets really bad at some point in time you will then do a strip procedure to get more grafts.

This sounds fine in theory, but let's say you have a few thousand grafts in the first FUE. You later go back to finish it off, do some touch up, add a little here and there, etc. You are not going to switch to strip. You are going to do another FUE of course. OK fine. A few years later when you lose a bit more hair the Dr tells you that you can still get one more FUE and of course you do that. At that point your donor is looking rather thin although manageable and you know you don't want to thin it out anymore as it's already getting see-through. You lose a bit more hair and you finally decide to switch to strip, but by then it's nearly impossible to get any meaningful amount of grafts in a strip surgery and with the thin donor that's left you will not be able to cover the strip scar even if you keep your hair long.

If you went with strip first you wouldn't have thinned out the donor above or below the strip, so if you needed to max out the grafts after several strip surgeries, you could still do some FUE strategically from areas to not let the strip scar be visible.

I just wanted to throw that out there as something to think about. There's no real right or wrong way as you get more benefits of going with FUE first in the early years, but you get more benefits of doing strip first in the later years. But even then it all depends on how much hair loss you end up with.

 

 

Edited April 12, 2019 by BeHappy

[JohnCasper]

I certainly respect the comments from the conversation in this thread. That’s why it’s so important to have a consultation with the surgeon to determine approximate yield.  I never wanted a lengthy FUT scar.  I was a Norwood VI and had 5,125 grafts transplanted in 2012 in one lengthy session over two and half days.  I later had 2,100 grafts in a “touch-up” procedure in particular areas a couple years later.

I was examined by many surgeons while on display at the International Hair Restoration Confernce the following year.  Several surgeons suggested that I had plenty of donor hair for another 2,000 grafts to thicken my crown area.  I was extremely pleased with my results and never had another surgery.  I may be a lucky guy and blessed with strong donor areas.

That said, don’t rule out a large surgery or two using only FUE.  An 0.8mm punch was used in my case in both surgeries.  You can get great results and never have the lengthy linear scar.  You may be one of those guys that have no problem with the linear scar.  I just wanted to share a personal story of large FUE yield with great results with potential for more using only FUE.

Best of luck to you.

 

[Wassermann]

I didn't know some aspects.
Thanks for the answers