FUE or FUT? Positives and negatives.

[HelpfulFriend]

Hey all,

I'm having trouble choosing between the two procedures.

I'm in a tricky spot, as I'm late 20's, NW3, and I'm not sure where my loss will end up.

I've been on finasteride and minox for about 3 years, but I know some people still end up losing their hair on medication.

I want to get FUT for maximal graft retention, and donor management, but I'm worried that I still may end up losing my hair overall - and then I really won't have the option to shave. 

I know FUE isn't scarless, but comparatively it is easier to hide with a buzz.

Has anyone grappled with the dilemma of:

a) waiting until they're older to get a procedure, whilst having to rock a hairline that is far too receded for their age; or -

b) having a procedure without knowing where exactly their loss will progress to?

Just feeling really mixed up at the moment about it all. I want to remedy this, but have read many a horror story of people wishing they'd never even got the operations.

For further clarification I don't look good shaved, but I'd opt for it over a very receded head of hair. 

Thanks so much.

[bonkling]

From this point of view, hair transplants are unfortunately always a risk.

No one can know for certain what their loss will progress to, some people don't even seem to follow their family history. 

It's good you are on medication, but as you said, some people continue to lose hair even on meds. It's really quite tricky.

Your best bet would be to opt for a very conservative approach, and seek out doctors who have great surgical techniques to minimise scarring.

[HelpfulFriend]

On 12/28/2019 at 7:53 PM, transplantedphil said:

I ask Bloxham a similar question about FUT vs FUE which I think might be helpful;

https://www.hairrestorationnetwork.com/topic/54672-hairlines-not-a-one-size-fits-all-dr-bloxham-2400-grafts-feller-bloxham/?tab=comments#comment-514986

This was a great read, thanks Phil.

[elduterino]

go for FUE as you can potentially use more grafts overall, if don't mind a thin back of the head, since you won't need hair to cover the scar

The scars will depend on the type of skin and punch size used, and FUE can be scarless if both factors are in your favor.

FUT is never scarless

Edited December 29, 2019 by elduterino
.

[Rafael Odreman]

Hello my name is Rafael Odreman MD I am hair transplant surgeon from South America, in my personal opinion i perform FUE and did some FUT before but i found that the amount of graft that we can get is limited, instead if i perform the FUE technique i can extract more than 2000 graft in less than 4 hour and also my patient will not have a linear scar that it is not cosmetic in the future. so you just have to decide if you like the scare or not and how much graft will you need to recover 55% on average of your density if any of you  have further  question regarding the technique feel free to write me down i will be happy to answer best regards 

[Melvin- Admin]

FUT pros- more efficient, slightly better growth (depends on the surgeon), more grafts can be excised in one session.

FUE pros- less invasive, less scarring, lower chance of nerve damage, quicker recovery.

FUT cons- linear scar, requires longer hair to conceal scar, chance of permanent nerve damage (rare), longer recovery time.

FUE cons- Slightly lower growth (yield), higher chance of donor depletion, more expensive (depends on where you live), more sessions required. 

[yesplease]

5 hours ago, elduterino said:

go for FUE as you can potentially use more grafts overall, if don't mind a thin back of the head, since you won't need hair to cover the scar

The scars will depend on the type of skin and punch size used, and FUE can be scarless if both factors are in your favor.

FUT is never scarless

Don’t want to start an argument here, but I don’t believe these statements are lll I’lll accurate. 
 

the best way to optimize the number of grafts you have access to over the long term is to have an FUT procedure first, and then proceed to “strip out” with one or possibly two additional FUT procedures further down the road before switching to FUE if necessary. 
 

FUE has many advantages, but I don’t think  “using more grafts overall” is one of them. 
 

Also, I don’t believe FUE is ever “scarless”. The scarring is different and more subtle than FUT for sure, but I’ve never seen a pic of someone with a truly shaved head (not just cropped or buzzed) that doesn’t reveal the dotted scarring of FUE. 

[elduterino]

I had two FUE and there is no dotted scarring at all. I have a fair skin which heals well and the docs used a smaller punch.

Maybe if I shave my head to a zero guard with razors, and someone came from behind with a magnifying glass they may notice something slightly different, perhaps, but in the real world this does not matter as it will never happen. If you don't mind being a bit bald at the back/side of your head and have a great hairline in return .. you will be able to get more grafts with FUE.

You cannot do this with FUT as you would need sufficient  hair to cover a  large visible scar. 

 

Edited December 31, 2019 by elduterino
.

[1978matt]

18 minutes ago, elduterino said:

 .. you will be able to get more grafts with FUE.

That is impossible to say for everyone as it is varies from person to person.  An accessible example that disproves this is the former H&W representative JT.  He could never have got the results he has via FUE alone.  In fact, he had an FUE about 6 months ago.

I am very glad I had an FUT first as in my situation it still allows another circa 4000 FUE total on top of 4300 via FUT.  I cant imagine how bare it would look with 16,000 hairs removed via FUE alone.

[abcd913651]

Having had an FUT done and consulted with various doctors for a second FUE procedure, I think I may be able to help out a bit. I think everyone else has already mentioned the pros and cons of one procedure over the other. I personally chose to undergo an FUT first to maximize the amount of grafts that can be extracted from my donor area. The doctor was able to obtain around 3300 grafts the first time around and from my consultation I have a further 5800 grafts left via FUE. I may have an above average donor area, but at the same time, my first procedure failed and only a third of the grafts grew. If I had gone with FUE first and had the procedure failed, I probably would not have had enough grafts for a repair operation. I guess FUT first, followed by FUE, just gives you a bit more hair to use, and in case you do advance to a high norwood stage, you might have enough grafts to achieve good density at the front and midscalp. with a slightly thin crown

[Curious]

How come your FUT procedure failed?

[elduterino]

Why would FUT maximize donor hair ? this statement does not make any sense.  If it would be true, no one would advocate having a FUE after a FUT.

In the past FUE was not able to achieve similar yield/survival rates, but these days with better tools such as the new extraction tools and implanter pens, the rates is similar to FUT so there isn't any magic graft maximization.

Plus, if you don't mind having a thin back of the head sporting a very short hair cut in the donor areas,  you can potentially extract even more grafts with FUE from there because you won't need to cover  any linear scars, provided of course you have the type of skin which heals with no scars, or even use Laser resurfacing if needed. This isn't even an option with FUT.

Edited January 1, 2020 by elduterino
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[yesplease]

37 minutes ago, elduterino said:

Why would FUT maximize donor hair ? this statement does not make any sense.  If it would be true, no one would advocate having a FUE after a FUT.

In the past FUE was not able to achieve similar yield/survival rates, but these days with better tools such as the new extraction tools and implanter pens, the rates is similar to FUT so there isn't any magic graft maximization.

Plus, if you don't mind having a thin back of the head sporting a very short hair cut in the donor areas,  you can potentially extract even more grafts with FUE from there because you won't need to cover  any linear scars, provided of course you have the type of skin which heals with no scars, or even use Laser resurfacing if needed. This isn't even an option with FUT.

Rather than get into a back and forth, let’s just advise the OP to ask his hair surgeon (or any reputable hair surgeon) which strategy is optimal for maximizing donor supply over the course of one’s lifetime. I would be willing to bet any amount that the answer will be FUT followed by FUE.

Also, is this picture of you following your two FUE procedures? If not, can you post a picture of your current donor area with the hair shaved down in the manner that you’re advocating? 
 

Perhaps you had the perfect storm of skin tone, healing/physiology and luck. But I have never seen a photo of someone’s donor area shaved down after an FUE that doesn’t reveal the scarring. And even if there are some people out there whose scarring is extremely minimal/subtle, it’s bad advice to purport that the FUE procedure does not produce noticeable scarring. It most certainly does for the vast majority of patients. 
 

Again, to the OP, ask a surgeon if FUE is “scarless” and see what he/she says. 

[1978matt]

https://www.bernsteinmedical.com/hair-transplant/fue/fue-vs-fut/

“Although new techniques and instrumentation significantly decrease the amount of transection and damage during the extraction process, the inability to fully access the mid-portion of the permanent zone in a hair transplant procedure still limits the total amount of hair available with FUE. This represents a significant disadvantage of FUE since a limited donor supply is the main factor that prevents a complete hair restoration in many patients, particularly those with moderate to advanced balding.”

https://bhrclinic.com/fue-or-fut-first-thats-the-question/

“FUE due to the technical demands of the procedure being labour and time intensive as well as the medical healing and yield concerns is better suited to smaller sessions for the majority of hair loss sufferers. If the pattern of hair loss is high and the goal is to cover a large surface area with a natural looking density then FUT would be the sensible and obvious choice to achieve the best result for the candidate.”

https://www.themaitlandclinic.com/difference-between-fue-fut-transplants/

“The long-term donor hair supply will be influenced by how loose (or lax) the scalp skin is and by how many hairs there are per square centimetre of donor scalp. Generally speaking, the FUT procedure gives access to a greater donor hair yield during a lifetime compared with FUE”

http://shapiromedical.com/procedure-page/follicular-unit-extraction-fue/disadvantages-of-fue/

“In my opinion the potential for getting the most grafts out of a patient exist when using both techniques together. As stated earlier it is important to be good at both techniques. In some patients exclusive FUE is best; In others exclusive FUT is best; and in many a combination may be the best approach to get the maximum number of grafts.”

[yesplease]

1 hour ago, 1978matt said:

https://www.bernsteinmedical.com/hair-transplant/fue/fue-vs-fut/

 

“Although new techniques and instrumentation significantly decrease the amount of transection and damage during the extraction process, the inability to fully access the mid-portion of the permanent zone in a hair transplant procedure still limits the total amount of hair available with FUE. This represents a significant disadvantage of FUE since a limited donor supply is the main factor that prevents a complete hair restoration in many patients, particularly those with moderate to advanced balding.”

 

https://bhrclinic.com/fue-or-fut-first-thats-the-question/

 

“FUE due to the technical demands of the procedure being labour and time intensive as well as the medical healing and yield concerns is better suited to smaller sessions for the majority of hair loss sufferers. If the pattern of hair loss is high and the goal is to cover a large surface area with a natural looking density then FUT would be the sensible and obvious choice to achieve the best result for the candidate.”

 

https://www.themaitlandclinic.com/difference-between-fue-fut-transplants/

 

“The long-term donor hair supply will be influenced by how loose (or lax) the scalp skin is and by how many hairs there are per square centimetre of donor scalp. Generally speaking, the FUT procedure gives access to a greater donor hair yield during a lifetime compared with FUE”

 

http://shapiromedical.com/procedure-page/follicular-unit-extraction-fue/disadvantages-of-fue/

 

“In my opinion the potential for getting the most grafts out of a patient exist when using both techniques together. As stated earlier it is important to be good at both techniques. In some patients exclusive FUE is best; In others exclusive FUT is best; and in many a combination may be the best approach to get the maximum number of grafts.”

 

Exactly. Thank you, Matt, for doing the legwork that I was too busy to do at the moment. 
 

I’m not a preferential proponent of either technique per se. FUE definitely has its advantages and I can understand why it has become so popular. Just don’t want to see any misinformation being spread to the OP or others reading this thread who are just beginning to research HTs. 

[elduterino]

This statement from Bernstein Medical is not relevant today. The transection rate is not an issue these days, and since they do not perform manual FUE at all, they traditionally like to sell patients the idea of FUT as they have been doing FUT all these years.

There is not such thing as  inability to fully access the mid-portion of the permanent zone. 

In 2011, Bernstein Medical – Center for Hair Restoration began offering FUE hair transplants using the ARTAS® robotic system, developed by Restoration Robotics, for the extraction of follicular unit grafts. We are now performing all of our FUE transplant procedures using this technology. 

 

 

The main advantage of FUT is for the doc, and is motivated by money and workload.

 In the US legally only docs can do cuts to the skin of patients. All they have to do is spend 15 minutes cutting a strip of skin  then come back and do the incisions. Maybe spend 1 hour in total for one HT and get the full revenues as all the rest of the work is handed to techs.

And if the patient really does not want the linear scar, send him to the robot...

Most docs don't want to spend hours doing the extractions manually and then using a manual implanter pen .

Only the top docs like Couto with constant excellent results do it, and have in a waiting list of 3 years.

 

Edited January 2, 2020 by elduterino
.

[1978matt]

2 hours ago, elduterino said:

There is not such thing as  inability to fully access the mid-portion of the permanent zone. 

Not sure you understand what this means, it means you cannot FUE out all of the upper shaded region below, otherwise you would be left with a patch of bare scalp.  FUT allows the highest proportion of this to be removed with the edges joined together to form a linear scar:

 

2 hours ago, elduterino said:

The main advantage of FUT is for the doc, and is motivated by money and workload.

 In the US legally only docs can do cuts to the skin of patients. All they have to do is spend 15 minutes cutting a strip of skin  then come back and do the incisions. Maybe spend 1 hour in total for one HT and get the full revenues as all the rest of the work is handed to techs.

And if the patient really does not want the linear scar, send him to the robot...

Most docs don't want to spend hours doing the extractions manually and then using a manual implanter pen .

Only the top docs like Couto with constant excellent results do it, and have in a waiting list of 3 years.

This is the same nonsense that gets parroted by the FUE-only brigade when they have lost the argument.  It can easily be flipped on its head to apply to FUE:

• The main advantage of FUE is for the doc, and is motivated by money and workload.
• In many countries it is not illegal for technicians to cut the skin of patients.  All the doctors have to do is mark the patient hairline and then come back to do the incisions.  Maybe spend 1 hour in total on 2+ or more patients and then pay technicians minimum wage to do the extractions.
• And if the patients really wants full coverage, overharvest them!  The more money the better!
• Most docs don't want to or aren't capable of learning how to do FUT...they are lazy and would rather watch technicians on a video screen.  It is easy money!

I have never seen a Couto patient posted result, only the cherry picked ones on youtube where most of the donor densities are off the charts.

 

 

Edited January 2, 2020 by 1978matt

[elduterino]

Not sure you understand what this means, it means you cannot FUE out all of the upper shaded region below, otherwise you would be left with a patch of bare scalp.  FUT allows the highest proprotion of this to be removed with the edges joined together to form a linear scar:

Provided your skin type heals well and the doc used a small punch - Yes you can FUE out all of the safe zone , then shave around it and end up with the military hair cut like I posted the pic, with bare scalp at the side and back.

This will maximize the grafts.

And with FUT, no you cannot strip out all the safe area because you still would need sufficient hair left over to cover the scar, then enough hair left around it to match the hair density which covers the scar, and such a large area strip cut would create an even larger and far uglier scar.

I am not saying that FUE is always scarless, my point is that it CAN BE scarless. And even if you still are unlucky and end up having  tiny scars, you are still left with good options such as laser resurfacing which works well for smoothing out moderate acne scars. These acne scars are far deeper and larger than 0.9mm punch marks.

[Melvin- Admin]

I think we can all agree that combining both methods will always give you more hair, if you were to combine FUT+FUE you will still be able to harvest hair from other areas of the body like the chest and beard. That said, you can still have an FUT after FUE, but it's not as good because of the sub-dermal scarring, you will get less grafts, and the healthier and more robust grafts would probably be already FUE'd out. 

[1978matt]

4 minutes ago, elduterino said:

Provided your skin type heals well and the doc used a small punch - Yes you can FUE out all of the safe zone , then shave around it and end up with the military hair cut like I posted the pic, with bare scalp at the side and back.

This will maximize the grafts.

Bizarre and I have never seen or heard a doctor suggest it or even seen a result like this, perhaps because it wouldn't work.  FUE is not 100% transection free either, even with the best tools.  You would also be left with a fringe on hair around the perimeter of the FUE safe zone, or are you suggesting that is extracted too?  You would be looking at 50,000+ extractions.  Expensive.

4 minutes ago, elduterino said:

And with FUT, no you cannot strip out all the safe area because you still would need sufficient hair left over to cover the scar, then enough hair left around it to match the hair density which covers the scar, and such a large area strip cut would create an even larger and far uglier scar.

I am not saying that FUE is always scarless, my point is that it CAN BE scarless. And even if you still are unlucky and end up having  tiny scars, you are still left with good options such as laser resurfacing which works well for smoothing out moderate acne scars. These acne scars are far deeper and larger than 0.9mm punch marks.

You might not get all of the safest zone but a large section of it.  Hair above an below should hide the scar provided it is sufficiently long enough.  FUE can then be used selectively in the inferior zone below the scar and elsewhere.

FUE always leaves dot scars, at least the size of pinhead.  

 

[gilgamesh]

Ah starting off 2020 with an oldie but a goodie.. the old Scar vs Yield thread

Poster 1: I believe FUE is the future and that new clinics are getting the same yields with a less recognizable scar. Coincidentally I have had this exact surgery and I do not believe confirmation bias and cognitive dissonance are at play here. It's just a coincidence.
Poster 2: Well that's not what Dr. So and So said. FUT will always have better yield than FUE because 1) yields within a single surgery are better and 2) it lets you have a greater number of total procedures. Also I have had FUT and I do not believe this is impacting my decision to support FUTs.
Poster 1: Dr. So and So sucks he isn't as good as Dr. This and That. Based on my review of online cases and my n of 1 experience, I feel confident in letting you know that you're living in the past.
Poster 2: Dr. This and That lives in <x> country where there is no rule of law, I don't trust his results. All because a procedure is new doesn't mean it is better.
Poster 1: It's all about money. You're a shill.
Poster 2: It's all about money. You're a shill.
Poster 1: Troll.
Poster 2: Troll.

They used to have this argument about open heart surgery vs bypass until the numbers came out in peer reviewed journals. Until then, we continue on the merry-go-round.

Also 1978Matt, I'm surprised you're not able to find cases from Couto's patients? How about recuperarelpelo? Just turn auto translate on if you can't understand Spanish. His donor extractions are large, but his yields within a single surgery are solid. Freitas and Lorenzo are strong as well, though possibly a half step below in some instances. There are a few other names there, I think they've figured something out.

My hunch is that the numbers will eventually show us that stripping out then FUE has the most robust and greatest lifetime yield, and that the excellent short term results from the FUE files of Couto, Freitas etc will be outweighed by a devastatingly low lifetime yield, but you never know. It could end up being the exact opposite.

Edited January 2, 2020 by gilgamesh

[Melvin- Admin]

The FUT vs FUE threads are what keeps this forum thriving, it's good to have a difference of opinion, otherwise you're in an echo chamber. I can recall about 5 years ago being pro-FUE, at the time Matt was very pro-FUT, but now I have come to realize how important the FUT technique is to the industry, and Matt has gone on to have a successful FUE. I think it's better to start FUT if that's what you want to do, you will definitely be able to get more hair long-term.

That said, there are plenty of examples of FUE being utilized and restoring advanced norwoods like myself. Given the choice to do it over again, I wouldn't change a thing, though I can recognize that I would probably have more hair had I gone strip first. I can cut my hair short and dab on some concealer in the crown, so i'm definitely happy about that, but not everyone is the same. This is why you need to be fully educated, and have a clear understanding of your goals.

[elduterino]

You would also be left with a fringe on hair around the perimeter of the FUE safe zone, or are you suggesting that is extracted too?  You would be looking at 50,000+ extractions.  Expensive.

No. You would only need to shave it regularly, just like many bald guys do everyday. If you are fine with this, then you can transplant far more head grafts from FUE than FUT overall.

FUE always leaves dot scars, at least the size of pinhead.  

That is not true. The photos you have seen are the ones posted by guys not too long ago after the HT. It may take a year but over time the pigmentation of the skin returns to normal, provided it is low in melanin, and the skin levels off. 

And even if the skin did not level, you still have the viable laser ablation option which can not be used for a FUT scar.

Why are we seeing all these threads on FUT scar revision, FUE into FUT scar, SMP into FUT scar etc.. and none related to FUE scars ? 

 

Edited January 3, 2020 by elduterino

[Dr Abhinav Kumar]

13 hours ago, 1978matt said:

Not sure you understand what this means, it means you cannot FUE out all of the upper shaded region below, otherwise you would be left with a patch of bare scalp.  FUT allows the highest proportion of this to be removed with the edges joined together to form a linear scar:

 

This is the same nonsense that gets parroted by the FUE-only brigade when they have lost the argument.  It can easily be flipped on its head to apply to FUE:

• The main advantage of FUE is for the doc, and is motivated by money and workload.
• In many countries it is not illegal for technicians to cut the skin of patients.  All the doctors have to do is mark the patient hairline and then come back to do the incisions.  Maybe spend 1 hour in total on 2+ or more patients and then pay technicians minimum wage to do the extractions.
• And if the patients really wants full coverage, overharvest them!  The more money the better!
• Most docs don't want to or aren't capable of learning how to do FUT...they are lazy and would rather watch technicians on a video screen.  It is easy money!

I have never seen a Couto patient posted result, only the cherry picked ones on youtube where most of the donor densities are off the charts.

I totally agree with you. I am exclusive FUE surgeon. I am young and 32 yra of age with experience of 200 FUE surgeries. This surgery was being taught to me and learnt it diligently. FUT being a old technique was not taught to me by current surgeons cum mentors. That limits my capability . I agree that FUT if done right is the way to go. Both the surgery types are technician dependent and using qualified technicians is not bad. Scoring of grafts shoudl be done by doctor and implantation by either assistants or doctors. No surgery is humanly possible without assistants. The only thing is they should be qualified not some low cost labour. Although Dr counto  results are wow.. it will well evident that safe donor area is breached for the results for high density. The density can dip after 3 to 4 years as thinning happens even when you are on finasteride. 7 to 9 months results is no guarantee to longevity of results. 

 

 

Edited January 3, 2020 by Dr Abhinav Kumar

[gilgamesh]

4 hours ago, Dr Abhinav Kumar said:

I m myself a FUE surgeon😊

Thanks for your fair handed assessment in the setting of your professional niche.