Fut/fue? Same result?

[Hair4Days]

For something so serious as surgery, something that creates permanent scarring.. I’ve never seen so many conflicting inputs on hair restoration. I’ve consulted with 6 different hair transplant doctors, all with separate game plans. You would think there would be Atleast some kind of universal understanding about grafts, coverage, density..I know it depends on the skill of the surgeon..but for someone to completely disagree with starting with FUT, and then another doctor saying stay far away from FUE.. it just causes confusion and makes patients indecisive about a decision so crucial to a mans life. 
I was coming to the overall conclusion that (And I’m sure a lot of you guys would agree) the only way to extract the most lifetime grafts is FUT first, and then FUE second. This was explained to me during a few of my consults, so Atleast some were on the same page. But then i do further research and consult with other doctors for another opinion. Then i hear FUE can yield just as much and get you the same result as an FUT strip. This same doctor Includes beard hair in the overall strategy of obtaining full coverage, and highly advises against strip.

As a 28 year old, i just want to feel confident moving into surgery. I don’t want to regret starting fut if i can get the same result via fue. I wish more professionals AGREED on these  topics so i could better weigh my options and make an executive decision. Does anyone have an opinion on the better strategy. Would an fue case of 2500 grafts give me the same result as a 2500 strip? My donor hair is above average, with diffused thinning front to back (eventual nw6)
 

 

[ciaus]

With FUT you are less likely to damage the individual grafts during extraction/insertion prep, but eventually you will run out of scalp elasticity due to removing the skin strips. If you've already lost alot/or have an aggressive loss pattern, and know you are always going to wear your hair long enough to cover the FUT scars, start with FUT procedures until your scalp skin starts to approach the tightness limit and then do FUEs

[Hair4Days]

42 minutes ago, ciaus said:

With FUT you are less likely to damage the individual grafts during extraction/insertion prep, but eventually you will run out of scalp elasticity due to removing the skin strips. If you've already lost alot/or have an aggressive loss pattern, and know you are always going to wear your hair long enough to cover the FUT scars, start with FUT procedures until your scalp skin starts to approach the tightness limit and then do FUEs

And the alternative is just fue with similar results? Or are you on board with fue alone yields less lifetime grafts? Some doctors don’t agree with this 

Edited August 17, 2020 by James C

[ciaus]

Some clinics do say they are good enough to get similar yields with FUE, but the way I look at it why risk the extra handling of your grafts during extraction and insertion prep (esp if its being done by lab techs instead of the doc) when you know you will always have your hair longer in the donor area anyway. And with all FUE procedures you also need to be concerned about un-even density in your donor -depending on how evenly they extract the hairs across your donor area, and if you have any permanent shock loss spots. This would be more noticeable the shorter you cut your hair of course.  

[Hair4Days]

22 minutes ago, ciaus said:

Some clinics do say they are good enough to get similar yields with FUE, but the way I look at it why risk the extra handling of your grafts during extraction and insertion prep (esp if its being done by lab techs instead of the doc) when you know you will always have your hair longer in the donor area anyway. And with all FUE procedures you also need to be concerned about un-even density in your donor -depending on how evenly they extract the hairs across your donor area, and if you have any permanent shock loss spots. This would be more noticeable the shorter you cut your hair of course.  

I’m with you on that. But you can also argue- why risk having a linear scar when it’s possible to get similar results via fue? I think we can all agree that fue scarring is probably better then having a strip scar. And about the longer hair in the donor- i feel like i need to know for a fact if I’ll be able to address my crown enough where it won’t look bad with long donor hair. Imagine having a bald or thin crown and long hair on the sides. Atleast with fue they say you can cut your sides down lower .. which would ultimately make the top less noticeable. But if i get good coverage then the length on the sides don’t matter as much - which goes back to the question of which method yeilds more grafts. And i was always under the impression  fut then fue will max out the donor. But I’ve had enough consultations where some doctors contradict this philosophy and claim fue can do just as good.  And that’s when the confusion begins 

[ciaus]

13 minutes ago, James C said:

Imagine having a bald or thin crown and long hair on the sides

Yea that's where alot of guys break down and go get their first procedure

Less scarring is always better in terms of giving you more styling options, even if you are one of those guys that has more visible FUE scarring it wouldn't be as bad as a strip scar. But since you aren't going to take the meds your final outcome is more in doubt. So maybe split the difference, start off with some FUE to give you some acceptable density for now, then see how your loss progresses, if more aggressively have your middle procedures be FUT, and then do your final procedures and touch ups with FUE.

 

This is a link to one of the top clinics on here about disadvantages to fue etc, worth a look.

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

[asterix0]

The reason is because transparency in this industry is very poor. There is no regulation, no universal standards, very little research output to reference. 

Why do you never see before and after pictures from clinics of the same hair lengths, but rather these heavy combovers in different lighting conditions? Why can't you find yield statistics for each surgeon, and why can't you get this information from surgeons if you ask? Getting an answer of "very good" doesn't quite cut it for the level of detail I would expect patients to ask for during a consultation.

Why do you have to sign waivers that stipulate nothing is guaranteed at all for the procedure? Isn't this supposed to be some sort of science performed by a highly trained professional, who would have the foresight to examine a patient's hair via the best technological tools available to see if they are a viable candidate?

Unfortunately, this procedure requires patients to take a blind leap of faith, and all the risk falls on them. There are no refunds for botched or poor procedures. You are left with a depleted donor, potentially terrible scaring, disfigurement, while the doctor runs of with your bag of money and no repercussions.

The best you can hope for is find the best possible surgeon you can, save up enough $, and hope everything goes well. Preferably with a smaller procedure size, 2000-2500 FUE or so, so you still have donor reserves if things go wrong.

[Hair4Days]

32 minutes ago, asterix0 said:

The reason is because transparency in this industry is very poor. There is no regulation, no universal standards, very little research output to reference. 

Why do you never see before and after pictures from clinics of the same hair lengths, but rather these heavy combovers in different lighting conditions? Why can't you find yield statistics for each surgeon, and why can't you get this information from surgeons if you ask? Getting an answer of "very good" doesn't quite cut it for the level of detail I would expect patients to ask for during a consultation.

Why do you have to sign waivers that stipulate nothing is guaranteed at all for the procedure? Isn't this supposed to be some sort of science performed by a highly trained professional, who would have the foresight to examine a patient's hair via the best technological tools available to see if they are a viable candidate?

Unfortunately, this procedure requires patients to take a blind leap of faith, and all the risk falls on them. There are no refunds for botched or poor procedures. You are left with a depleted donor, potentially terrible scaring, disfigurement, while the doctor runs of with your bag of money and no repercussions.

The best you can hope for is find the best possible surgeon you can, save up enough $, and hope everything goes well. Preferably with a smaller procedure size, 2000-2500 FUE or so, so you still have donor reserves if things go wrong.

Perfectly said. Every point you made is true & valid. A lot of these doctors are pretty sketchy. The only time I’m impressed is when i see wet comb through videos. Other then that- you can keep the before and after photos for those who don’t use critical thinking for such a serious procedure. I’m glad I’m indecisive, because it gives me the opportunity to point out the flaws in this industry. Literally zero across the board standards when it comes to strategizing. I understand millions of men bald differently, but i was literally told yesterday to start with fue, and i have apparent crown diffusion that’s dipping into a severe advanced pattern. When a different surgeon says to completely forget about fue because in order to utilitize every available graft you must start with strip? Why do two surgeons in the same field have completely different game plans? You don’t know who to trust or believe. If I’m not getting a guarantee that my results will Atleast be 90% satisfying then I’m not dropping 15-30k, and I’m sure as hell not scarring my head. Until things become more universal i believe this industry will always be a coin flip 

Edited August 17, 2020 by James C

[ciaus]

26 minutes ago, asterix0 said:

Why do you have to sign waivers that stipulate nothing is guaranteed at all for the procedure? Isn't this supposed to be some sort of science performed by a highly trained professional, who would have the foresight to examine a patient's hair via the best technological tools available to see if they are a viable candidate?

While I agree with your general skeptical stance, which is why forums like this exist, there are variables like how well the patients follow post-op instructions and unforeseeable physiological factors that go into whether the hairs will take root and survive in the new location.

[asterix0]

14 minutes ago, ciaus said:

While I agree with your general skeptical stance, which is why forums like this exist, there are variables like how well the patients follow post-op instructions and unforeseeable physiological factors that go into whether the hairs will take root and survive in the new location.

Of course. But are these factors truly unknown to someone who should be an "expert" in this field, the person actually cutting your head open?

Would they not be able to guarantee, at least let's say, 70% yield? Or at least tell you if you should expect poor yield? Is this procedure so truly unknown that no one can guarantee anything?

That seems like quite a big dice roll, one that isn't quite fair that the patient should bear all the burden. Where is the line drawn between poor surgeon skill and "unforeseeable physiological factors"?

[asterix0]

23 minutes ago, James C said:

Perfectly said. Every point you made is true & valid. A lot of these doctors are pretty sketchy. The only time I’m impressed is when i see wet comb through videos. Other then that- you can keep the before and after photos for those who don’t use critical thinking for such a serious procedure. I’m glad I’m indecisive, because it gives me the opportunity to point out the flaws in this industry. Literally zero across the board standards when it comes to strategizing. I understand millions of men bald differently, but i was literally told yesterday to start with fue, and i have apparent crown diffusion that’s dipping into a severe advanced pattern. When a different surgeon says to completely forget about fue because in order to utilitize every available graft you must start with strip? Why do two surgeons in the same field have completely different game plans? You don’t know who to trust or believe. If I’m not getting a guarantee that my results will Atleast be 90% satisfying then I’m not dropping 15-30k, and I’m sure as hell not scarring my head. Until things become more universal i believe this industry will always be a coin flip 

I was told by a very reputable surgeon that FUT is an outdated procedure and that he exclusively recommends FUE for me, despite my eventual pattern obviously heading for Norwood 5 and 6. I have read on here certain surgeons championing FUT, claiming much better yields and more grafts than via FUE, yet failing to cite specific numbers and just randomly giving values such as "75%". I have read surgeons claiming the potential for nerve damage is much higher for FUT. I have read the same being claimed for FUE.

Could you imagine if this is how discourse went for oncology? For heart surgery? 

Now, one may argue I'm splitting hairs here. You can argue, well just look at the pictures, why would I care if I got a 85% yield versus an 80%, if it looks cosmetically good then that's all that matters.

Sure, this flies when everything goes fine and dandy and you get the result you want. What about all the unhappy patients, the patients needing repair work, who are disfigured and can't even shave their heads and bald with dignity?

[Hair4Days]

9 minutes ago, asterix0 said:

I was told by a very reputable surgeon that FUT is an outdated procedure and that he exclusively recommends FUE for me, despite my eventual pattern obviously heading for Norwood 5 and 6. I have read on here certain surgeons championing FUT, claiming much better yields and more grafts than via FUE, yet failing to cite specific numbers and just randomly giving values such as "75%". I have read surgeons claiming the potential for nerve damage is much higher for FUT. I have read the same being claimed for FUE.

Could you imagine if this is how discourse went for oncology? For heart surgery? 

Now, one may argue I'm splitting hairs here. You can argue, well just look at the pictures, why would I care if I got a 85% yield versus an 80%, if it looks cosmetically good then that's all that matters.

Sure, this flies when everything goes fine and dandy and you get the result you want. What about all the unhappy patients, the patients needing repair work, who are disfigured and can't even shave their heads and bald with dignity?

I do understandPhysiological factors is the key phrase people over look. The way human biology and physiology works Varys from person to person . Since that’s proven to be true, there’s no way a doctor can gaurentee the same results for every single person . I get that. However.. the contradicting opinions i get make me so damn indecisive for the last point you made about being unable to shave their head. I don’t want to be that guy who regrets the hell out of his decision- being forced to wear long hair on the sides.. with garbage density up top. 
Lol at if other industries having such loose standards. I remember when i tore my labrum in my shoulder- all 3 surgeons said arthroscopic repair with 4 anchors. At that point it was just about choosing who i felt most comfortable with. There was a universal orthopedic understanding of how the repair needs to be done. One guy didn’t have a completely separate strategy. With Ht, it’s literally all over the place

Edited August 17, 2020 by James C