About to commit - different doc recommendations.

[Greg_Swanson]

Hey gang,

Long, long-time lurker of this forum and many others, but first time poster. 

I'm about to commit to my first transplant, and have narrowed it down to a couple of docs. 

A little back-story, I'm 29, living in NZ, and am sitting about a early NW3. Nothing too bad, mostly temple recession and hair line a little higher than it used to be. I wear my hair long, and always have, so scarring isn't really a concern. I'm also aware that I will need a couple more transplants down the road due to my family history. 

I'm also on finasteride and have been for a few years.

All three surgeons have recommended 1800-2000 grafts to restore the front of my melon. 

Two have suggested FUE, one has suggested FUT - all three are extremely reputable and frequent contributors to this cite. Budget isn't too much of an issue, but I'd still like to save some costs if possible. Prices will range between 10-13k for all of them. Two are FUT specialists, the other is FUE.

I'm wondering if anyone else has been in this situation, and what deciding factors helped them come to a final decision? 

Thanks all.

[Upshall]

Will need the name of the docs 

[RecessionProof]

You might want to start with FUT since a few top doctors have told me that starting with strip is the best way to maximize donor supply. This would especially benefit you since you’re fairly young and might bald significantly later. That said, if you’re sure this will be your only transplant then maybe FUE would be better.

 

I originally wanted FUE but switched for the reason above, and also because the top FUT doctors produce a scar that is extremely hard to see (most can shave down to a 3-5 guard depending on scar physiology).

If you’d like to name your contenders so far, we can help point out how they differ to help you make your final decision. 

[Greg_Swanson]

24 minutes ago, Upshall said:

Will need the name of the docs 

Hasson and Wong, and Lupanzala.

17 minutes ago, RecessionProof said:

You might want to start with FUT since a few top doctors have told me that starting with strip is the best way to maximize donor supply. This would especially benefit you since you’re fairly young and might bald significantly later. That said, if you’re sure this will be your only transplant then maybe FUE would be better.

 

I originally wanted FUE but switched for the reason above, and also because the top FUT doctors produce a scar that is extremely hard to see (most can shave down to a 3-5 guard depending on scar physiology).

If you’d like to name your contenders so far, we can help point out how they differ to help you make your final decision. 

I was thinking the same mate. 

I will definitely need more, unless for some absurd reason the genes encoding for my recession simply switch off.

I've also seen work by Cooley, Konior, and Feller and Bloxham in which their patients had very minimal scarring - which gave me a promising outlook for FUT.

Were you happy with your FUT decision?

Thanks for the help. 

Edited April 11, 2019 by Greg_Swanson

[Kiwi Guy]

Hey bro, fellow NZ native here too, good luck on your decision, I've been doing a lot of research trying to find the right doc to do my hair transplant with as well, I know quite a bit about each of the top ones at this point due to the research, if you want any info just PM on here.
 

In terms of the surgeons you stated, both a very well renowned... have you had online consultations with both clinics?

Also has the FIN stabilized your hair fall? If not, just based on that alone and knowing your family history I would suggest going with FUT as it is known to produce a better yield of grafts, leaves the donor in better condition for future procedures and also because it is a significant amount cheaper than FUE.

[Raphael84]

@Greg_Swanson

To be honest, you mention some very reputable and highly esteemed physicians. You have obviously been doing your research which is very important.

Regarding your choice in FUT or FUE, depending on your level of loss, age, family history etc... 

I had FUT with Dr Rahal in 2012, I can cut my hair short but not too short and I feel that I have a "very good/small" scar. The interesting thing that I have found, that was never discussed on the forums pre 2012, and despite conducting research for several years I never heard of it, is that when the strip is taken, the hair directly above and below, don't necessarily grow in the same direction. So when my hair is short, you don't necessarily see a scar, but you see an obvious "line" in my donor area that is the hairs growing at different angles. Pretty logical and obvious really.

Would I personally consider FUT now? No. I see no need to. But it is a personal decision. FUE with the best Drs is very consistent now. It wasn't in 2012. If you can achieve your required/realistic results through FUE, then I would suggest to avoid the strip scar. 

It is a personal decision which ultimately lies with you.

[RecessionProof]

4 hours ago, Greg_Swanson said:

Hasson and Wong, and Lupanzala.

I was thinking the same mate. 

I will definitely need more, unless for some absurd reason the genes encoding for my recession simply switch off.

I've also seen work by Cooley, Konior, and Feller and Bloxham in which their patients had very minimal scarring - which gave me a promising outlook for FUT.

Were you happy with your FUT decision?

Thanks for the help. 

I had FUT with Konior literally 2 days ago. One of the easiest medical experiences I've ever had and there's been pretty much no post operative pain or bleeding (I've had a little swelling/oozing around the incision in back, but it hasn't really bothered me). He agreed that starting with FUT and moving on to FUE later was generally the best way to maximize donor use.

All of the names you mention are super high quality and capable of producing scars that are almost invisible (I'm not as familiar with Lupanzula but have heard good things). Cooley probably performs the highest number of no shave surgeries of the people you listed, though Konior has done a bunch of those as well.

Bloxham and Cooley have both posted some really nice and informative videos, so I'd definitely check those out if you haven't already. Obviously Bloxham is younger and not as experienced as some of the other names you mentioned, but his results so far have been great and I'm sure his work will only keep getting better.

Hasson and Wong do very good work so it ultimately comes down to personal taste. I'll probably post my post-op Konior thread later today, so feel free to message me or check that out if you want more details on that.

[Melvin- Admin]

Raphael has very good points. That said, if you require a large amount of grafts I think FUT is the way to go. If you need a small number of grafts FUE may be more beneficial. However, it really depends on your goals and how short you wear your hair.

I have never left my hair longer than a #1 on the sides. In fact, before surgery I would cut my hair to a zero. Therefore, FUT was out of the question for me. However, that’s just me, if you’re a guy who wears his hair long, I see no benefit in choosing FUE.

[paddyirishman]

If you go with FUT you can disguise the scar with FUE later .

Discuss with the doctor.

............Paddy..........

[Raphael84]

45 minutes ago, paddyirishman said:

If you go with FUT you can disguise the scar with FUE later .

Discuss with the doctor.

............Paddy..........

@paddyirishman

Whilst you are quite right, you can graft into the scar with FUE in the future in necessary, and this is peace of mind. But I would suggest that in doing so, depending on the individual and their scalp elasticity and personal response to healing, you are using precious grafts that could be used elsewhere on your head. So the motivation to choose FUT due to "possibility of "larger" session sizes", is floored if then afterwards you must use more grafts to correct/enhance the appearance or lack there of it of your scar.

Also, many of the best FUE surgeons are now comfortable in grafting 3000+ grafts when appropriate in one day, so over 2 days a significantly large session can be achieved.

Again, the choice is personal but it is important to understand and consider the facts and what is realistic and what is possible. 

Edited April 12, 2019 by Raphael84

[mephesto]

3 minutes ago, Raphael84 said:

@paddyirishman

Whilst you are quite right, you can graft into the scar with FUE in the future in necessary, and this is peace of mind. But I would suggest that in doing so, depending on the individual and their scalp elasticity and personal response to healing, you are using precious grafts that could be used elsewhere on your head. So the motivation to choose FUT due to "possibility of "larger" session sizes", is floored if then afterwards you must use more grafts to correct/enhance the appearance or lack there of it of your scar.

Also, many of the best FUE surgeons are now comfortable in grafting 3000+ grafts when appropriate in one day, so over 2 days a significantly large session can be achieved.

Again, the choice is personal but it is important to understand and consider the facts and what is realistic and what is possible. 

What about for those of us who are young and have a family of high NW patterns? Should we go with FUT first or FUE with the possibility to buzz down if need be in the future?

Edited April 12, 2019 by mephesto

[Spaceman]

9 hours ago, Raphael84 said:

The interesting thing that I have found, that was never discussed on the forums pre 2012, and despite conducting research for several years I never heard of it, is that when the strip is taken, the hair directly above and below, don't necessarily grow in the same direction. So when my hair is short, you don't necessarily see a scar, but you see an obvious "line" in my donor area that is the hairs growing at different angles. Pretty logical and obvious really.

Yes, this is true. There can be a change of direction on either side of the FUT scar. Some doctors (eg Hasson) take that into account and remove the strip in a way that minimizes change of direction. Also, for those with wavy or curly hair, the change of direction if usually much less noticeable or even totally invisible. But one should definitely consider this point when choosing between FUT and FUE, especially if you have stick straight hair.

 

[RecessionProof]

2 hours ago, Raphael84 said:

@paddyirishman

Whilst you are quite right, you can graft into the scar with FUE in the future in necessary, and this is peace of mind. But I would suggest that in doing so, depending on the individual and their scalp elasticity and personal response to healing, you are using precious grafts that could be used elsewhere on your head. So the motivation to choose FUT due to "possibility of "larger" session sizes", is floored if then afterwards you must use more grafts to correct/enhance the appearance or lack there of it of your scar.

Also, many of the best FUE surgeons are now comfortable in grafting 3000+ grafts when appropriate in one day, so over 2 days a significantly large session can be achieved.

Again, the choice is personal but it is important to understand and consider the facts and what is realistic and what is possible. 

This is a valid point and an important thing to question: is the lifetime donor gain from choosing FUT first enough to balance out the grafts you'd need to fill in the scar later? Konior recently said that most patients need about 300 grafts to fill in a FUT scar, so the overall gain in grafts would have to exceed that (I would guess they typically do)

Edited April 12, 2019 by RecessionProof

[paddyirishman]

RAPHAEL84   yes everything you said is correct in relation to using precious grafts to disguise the FUT scar. All the other points with laxity and personal circumstances you raised are very appropriate also.

 However the overall mathematical gain of grafts would or should be higher overall if one was to go the FUT route and then for peace of mind later disguise the scar with FUE. Choosing your surgeon is critical and one that can carry out an FUT procedure  and has a solid reputation of leaving behind only a pencil line scar is a must. Of course personal healing will play its part also. Preparation by the patient months in advance of surgery in the form of scalp laxity exercises can be very beneficial also.

So overall if we take into account the above and very important point what RecessionProof stated regarding what Dr. Konior said about using approx 300 grafts to cover a FUT scar. You would and should not need to waste a large number of precious grafts.

Thats because he is a top surgeon and many like him that wont leave you with a scar that will need a thousand grafts to disguise.  As we know grafts are precious. 

Again its very important to choose a surgeon with a solid reputation,  dont make the mistake and go to the cheapest surgeon and think, "ah well ", you can fix the scar later if it dosent work out , in that case its to late and you would only be fooling yourself , and to put it like this ,using the old saying.......

" ROBBING PETER TO PAY PAUL "

As we know everybody circumstances are unique.

As we know choosing a surgeon with a solid reputation is a must . Not the cheapest .

...DISCUSS WITH YOUR DOCTOR...

......................Paddy.............

 

[Raphael84]

@paddyirishman

Well said and well written. That’s a nice post brother 👌

[paddyirishman]

Thank you RAPHAEL84 , thats very kind of you to go to the trouble to say so. I really appreciatd it.  I hope it helps somebody to make a better informed decision without any regrets.

......all the best......

.........Paddy........

13 hours ago, Raphael84 said:

@paddyirishman

Well said and well written. That’s a nice post brother 👌

 

[Greg_Swanson]

Some seriously awesome perspectives on here, thanks a lot, everyone. 

@Raphael84 that's interesting regarding the direction post-FUT, it's something I never considered.

I'm thinking of leaning towards FUT, just because my older brother and dad have advanced hair loss - so I need as many grafts as possible down the road.

Another thing I'm considering, is whether I preemptively get grafts into my hairline, or wait until that hair fades. This is something I'm sure the surgeon will have a better idea of.

Thanks again everyone, really appreciate the input 

[Sean]

Rapheal, the doc you went with mentioned that his fue matches his fut yield when I was initially considering fut.  So, i got fue as I was assured and here i am years later trying to figure this whole thing out and now amazed at the work your docs do ethically.      

Greg, you may want to think this through and see what procedure is good for you.  You can get FUT now but once you get FUE, then getting FUT later may not be as beneficial.  It will depend on your hair caliber and strength to see if FUE is viable or FUT is.  Best of luck.  

[Raphael84]

@Sean

I have followed many of your posts and discussion for years and always held big respect for you.

Regarding Rahal, I never personally considered FUE back in 2012. I felt the results seemed inconsistent and it was at that time around a 80/20 split in favour of FUT and so that was the majority of the results that I was subject to. I spoke with Rahal patients with similar loss and patterns to mine, spoke with Dr Rahal and after several years decided to schedule surgery. As you can see in my documentation I achieved early growth at around 4 months and things progressed very nicely, and I was ecstatic. I applauded the clinic and the Dr and spoke about my experience.

Fast forward almost 7 years to today, I have experienced further native hair loss where I would say that almost all of the hair in my frontal third and mid scalp is transplanted hair. My hairline isn’t good. It look great with native hair, natural, single hairs and an appropriate design. Now, whilst the position is fine, it looks to lack density, some double hairs in the hairline, and looks pluggy. Not at all natural. I do feel disappointed with my hairline. But I wasn’t aware that this was the case for several years.

Having said that, my quality of life took a huge improvement along with my confidence and all aspects of my life and continues to do so. So was it a success? Yes. With a few hundred grafts into the hairline I should be able to achieve a appropriately dense and natural hairline. 

I’m sorry I don’t quite understand the next part? “

Amazed at the work “my” docs do ethically.”

I have no relationship with Dr Rahal so are you referring to Drs Bisanga and John C?

Wishing you the best.

[Greg_Swanson]

9 hours ago, Sean said:

Rapheal, the doc you went with mentioned that his fue matches his fut yield when I was initially considering fut.  So, i got fue as I was assured and here i am years later trying to figure this whole thing out and now amazed at the work your docs do ethically.      

Greg, you may want to think this through and see what procedure is good for you.  You can get FUT now but once you get FUE, then getting FUT later may not be as beneficial.  It will depend on your hair caliber and strength to see if FUE is viable or FUT is.  Best of luck.  

Hey Sean, that makes a lot of sense.

As you said, I've also heard that this is the most logical way to proceed.

I will ask the surgeons, but I thinking of using FUT initially, to get the best grafts for the front of my hair, then potentially FUE later on - or maybe even more FUT. 

The scarring isn;t a concern as I've always liked having long hair, i.e. the shortest it ever gets is a 2, and is quite long on top.

Thanks again for the advice everyone.