FUE or DHI What's Better?

[Melvin- Admin]

Someone recently asked me this question, and I was a bit shocked that DHI has gotten so much hype. Comparing the two is like asking whether the washer is better than the dryer. Follicular unit grafts can survive almost 24 hours in the right holding solution, so the thought that grafts dry up and die within a few minutes if they're not immediately transplanted is false. I'd love to hear the communities thoughts?

FUE or DHI What’s Better?

[Sam818]

In my opinion, DHT and it’s benefits are borderline a marketing gimmick. The biggest issue I see with it is grafts are not trimmed of the excess skin before being placed. This increases the risk of grafts not being placed properly and healing incorrectly with skin irregularities like tenting. Basically what it comes down to is DHT is actually easier on clinics because they don’t have to dissect or trim any grafts so common sense tells me if it was beneficial I think every clinic would do it since it actually saves them time and effort. Maybe I’m wrong though and some doctors can actually give their opinions on the matter. 

[Melvin- Admin]

I’d say its past borderline. It’s a flat out gimmick in my opinion. You bring up some valid points.

[Coady]

I think dhi is just a marketing gimmick. The majority of people for some reason are under the assumption grafts die if they are out of the body a couple of hours. It’s just a clever way of giving uneducated HT people the idea that they can get a better result through this method. Usually low cost budget clinics offer dhi. Look at the top docs like Konior, diep, Hasson, Wong, none of them are doing dhi 

Edited August 17, 2020 by Coady

[Melvin- Admin]

@Coady funny you mention that, because Doug from hasson and wong brought up a patient that had 9,000 grafts in one sitting, and his hair grew spectacular well.

[Rolandas]

I believe what people really mean when they say DHI vs FUE is method of implantation (a.k.a. implanter pen vs pre-made slits + forceps). At least this is the case in Turkish market.

I had both pre-made slits and DHI in the same surgery and from my personal experience pre-made slits takes 2-4 weeks longer to heal (redness to disappear). That's it. So when someone is saying DHI has faster healing, they're not lying, but the difference is so minimal that it shouldn't even matter.

Another biggest pro for DHI is potential of implanting more graft/cm2. Although in reality nobody would ever implant 80 grafts/cm2 in one sitting. 50-60 grafts/cm2 can be done with pre-made slits as well.

 

This is just my observation of what people are talking about. I'm involved with lots of uneducated people that are asking similar questions.
This question is actually drives me mad, because FUE is actually an extraction method while DHI is just implantation method. It's incorrect to say pre-made slits = FUE. I even had a debate with one of cheap clinics in Turkey about it to what they responded that they're using FUE terminology only for SEO purposes as that's the most searchable word.

[LonelyGraft]

1 hour ago, Rolandas said:

I believe what people really mean when they say DHI vs FUE is method of implantation (a.k.a. implanter pen vs pre-made slits + forceps). At least this is the case in Turkish market.

I had both pre-made slits and DHI in the same surgery and from my personal experience pre-made slits takes 2-4 weeks longer to heal (redness to disappear). That's it. So when someone is saying DHI has faster healing, they're not lying, but the difference is so minimal that it shouldn't even matter.

Another biggest pro for DHI is potential of implanting more graft/cm2. Although in reality nobody would ever implant 80 grafts/cm2 in one sitting. 50-60 grafts/cm2 can be done with pre-made slits as well.

 

This is just my observation of what people are talking about. I'm involved with lots of uneducated people that are asking similar questions.
This question is actually drives me mad, because FUE is actually an extraction method while DHI is just implantation method. It's incorrect to say pre-made slits = FUE. I even had a debate with one of cheap clinics in Turkey about it to what they responded that they're using FUE terminology only for SEO purposes as that's the most searchable word.

Did your doctor create the pre made slits with sharp end of the implanter? It was done to make up for popping right?

[aaron1234]

I've been around the block but I have no clue what DHI is...  Direct Hair Implantation? 🤷‍♂️ Can someone explain it to me?

[Melvin- Admin]

4 hours ago, Rolandas said:

I believe what people really mean when they say DHI vs FUE is method of implantation (a.k.a. implanter pen vs pre-made slits + forceps). At least this is the case in Turkish market.

I had both pre-made slits and DHI in the same surgery and from my personal experience pre-made slits takes 2-4 weeks longer to heal (redness to disappear). That's it. So when someone is saying DHI has faster healing, they're not lying, but the difference is so minimal that it shouldn't even matter.

Another biggest pro for DHI is potential of implanting more graft/cm2. Although in reality nobody would ever implant 80 grafts/cm2 in one sitting. 50-60 grafts/cm2 can be done with pre-made slits as well.

 

This is just my observation of what people are talking about. I'm involved with lots of uneducated people that are asking similar questions.
This question is actually drives me mad, because FUE is actually an extraction method while DHI is just implantation method. It's incorrect to say pre-made slits = FUE. I even had a debate with one of cheap clinics in Turkey about it to what they responded that they're using FUE terminology only for SEO purposes as that's the most searchable word.

You hit the nail on the head, it’s all about marketing. SEO hot topics and terms. You can have FUE and DHI, so the fact these clinics are acting like they’re mutually exclusive is shocking.

[Rolandas]

8 hours ago, LonelyGraft said:

Did your doctor create the pre made slits with sharp end of the implanter? It was done to make up for popping right?

I'm really not sure as pre-made slits were done only in the hairline. 

Dr. Ferreira decided to do pre-made slits before any popping was even discovered, so I don't think this was the reason (unless of course he predicted given my elastic skin).

@Melvin-Moderator
Agreed. It was shocking to me when a clinic publicly said "we are lying to our potential patients just so we can rank higher in a google search".

[Melvin- Admin]

11 hours ago, aaron1234 said:

I've been around the block but I have no clue what DHI is...  Direct Hair Implantation? 🤷‍♂️ Can someone explain it to me?

Yea, so essentially, as soon as the grafts are extracted, they’re loaded into a pen and then implanted into the scalp. They’re no longer creating the slits, and then transplanting the grafts. The theory behind it is to minimize the time the grafts are out of the body.

[Morocci]

There are also clinics such as Cosmedica and Asmed, who make slits with saffier blade and then implant whit a pen. The reason why is because they say with forceps the hairfollicles have a greater chance to be damaged. With Dhi/implanter pen the follicles are directly placed in to the pen and are protected.

They claim that sometimes the technician cant find the slit or due to fatigue places the hair incorrect with forceps, and so the follicles dies. I think it s very understandable. Or is it just BS?

Reason why i ask this is because i am planning to have a beardtransplant and i m opting to go with cosmedica and choose the fue in combination with DHI technique done by dr Acar..I would like your opinions

[LonelyGraft]

12 minutes ago, Morocci said:

There are also clinics such as Cosmedica and Asmed, who make slits with saffier blade and then implant whit a pen. The reason why is because they say with forceps the hairfollicles have a greater chance to be damaged. With Dhi/implanter pen the follicles are directly placed in to the pen and are protected.

They claim that sometimes the technician cant find the slit or due to fatigue places the hair incorrect with forceps, and so the follicles dies. I think it s very understandable. Or is it just BS?

Reason why i ask this is because i am planning to have a beardtransplant and i m opting to go with cosmedica and choose the fue in combination with DHI technique done by dr Acar..I would like your opinions

Personally I would not go with acar. He runs a Turkish ht mill and I have seen a case of a badly depleted donor here. I think you get what u pay for in this case. Beware

[Morocci]

1 hour ago, LonelyGraft said:

Personally I would not go with acar. He runs a Turkish ht mill and I have seen a case of a badly depleted donor here. I think you get what u pay for in this case. Beware

Thanks for your reply!

[elduterino]

I had two FUE, one with the traditional lateral slit method and one with the implanter pens aka DHI.

In my experience DHI was much better, angle control at the side of the temples was much better, density was better and cobblestone/avocado skin was diminished, healing better

Here is a good study to read 

https://www.ishrs-htforum.org/content/27/3/96

[Melvin- Admin]

8 hours ago, elduterino said:

I had two FUE, one with the traditional lateral slit method and one with the implanter pens aka DHI.

In my experience DHI was much better, angle control at the side of the temples was much better, density was better and cobblestone/avocado skin was diminished, healing better

Here is a good study to read 

https://www.ishrs-htforum.org/content/27/3/96

That’s probably because the person performing DHI was comfortable with that method.  A clinic like Hasson and Wong are competent in doing the lateral slit technique, and they’re doing jus as good as any clinic in the world. To me, DHI is nothing more than a gimmick for many clinics. 

[elduterino]

The study on DHI highlights some valid advantages over the lateral slit method

The issue with North American clinics, is that by Law only doctors can do the cuts on human skins, so in the case of using the implanter pens the doctor would have to do all implantation work himself because slit and implantation is done manually by the pen in one step. This is how Dr Couto in Spain works, he uses implanter pens and he has world class results, but a long waiting list as he does most of the work himself.

A large clinic like H&W runs several surgeries in parallel and the docs only do the minimum required by law, which means that the techs do the implantation by forceps and the docs won't be able to use DHI as they would be limited to only one surgery per day, meaning less revenues, and a lot more work by the high payed docs.

In other countries the laws are not as strict or enforced, so clinics offering DHI can have a larger teams of techs pre-loading a multitude of implanter pens at the same time and helping the doc in implantation work at a faster pace, or doing most of it.

[Curious25]

I didn't realise Couto performed DHI. Do you know of any other top clinics/surgeons who are currently performing it? 

I'm not hugely adversed on the pro's vs con's - I briefly skim read the study you provided a link for, and noted that the implanter pens proved to be superior in terms of the percentage of damaged grafts. 

Similar to my views on the motorised punch vs. manual punch arguments - my overall instinct would be to conclude that a master of his trade is a master of his trade, regardless of what tools he is using. 

By that I mean, if a surgeon is getting kick ass results time after time again, to me thats what counts, and thats what I want to see - he could be using his Grandmothers tweezers for all I care. 

[Melvin- Admin]

5 hours ago, elduterino said:

The study on DHI highlights some valid advantages over the lateral slit method

The issue with North American clinics, is that by Law only doctors can do the cuts on human skins, so in the case of using the implanter pens the doctor would have to do all implantation work himself because slit and implantation is done manually by the pen in one step. This is how Dr Couto in Spain works, he uses implanter pens and he has world class results, but a long waiting list as he does most of the work himself.

A large clinic like H&W runs several surgeries in parallel and the docs only do the minimum required by law, which means that the techs do the implantation by forceps and the docs won't be able to use DHI as they would be limited to only one surgery per day, meaning less revenues, and a lot more work by the high payed docs.

In other countries the laws are not as strict or enforced, so clinics offering DHI can have a larger teams of techs pre-loading a multitude of implanter pens at the same time and helping the doc in implantation work at a faster pace, or doing most of it.

Actually it’s the opposite, in Canada technicians can do extractions, so they could have a dozen techs operating on 6 patients a day and only do the implantation with a pen. Similar to what they do in Turkey, where this “DHI” technique has received the most hype. They could easily triple their revenue and do less work. 

[aaron1234]

7 hours ago, elduterino said:

The issue with North American clinics, is that by Law only doctors can do the cuts on human skins

I believe that's just the USA, not Canada.

[elduterino]

So what are the Canadian docs required to do by law ?

[DrTBarghouthi]

I agree that these terms are all related to marketing and trying to attract patients by giving the perception that a new technique was invented. I think the method that a clinic is comfortable and skilled at performing daily is what it's all about. Provided the general rules of proper extraction, holding solutions, cooling and implantation techniques are adhered to. I personally like the sapphire blades for example. But these tools should never be used as marketing tools. 

[elduterino]

Here are two videos illustrating the two methods, notice how fast the docs can do the incisions at 0:47

At the bottom is DHI by another top worldwide doc, Dr Lorenzo.

In this video,  the doc is doing the implantation and each slit/graft stick is taking more time, plus he has to switch tools each time

It looks like the doc from the top video can easily do 3 incisions during the time it takes to do just 1 implanter pen graft placement, so multiply this by 2000 or 3000 and you can quickly see why a single doc will not be able to use DHI  as method  to operate on a multitude of patients in one afternoon.

Edited September 7, 2020 by elduterino

[Rolandas]

4 minutes ago, elduterino said:

Here are two videos illustrating the two methods, notice how fast the docs can do the incisions at 0:47

At the bottom is DHI by another top worldwide doc, Dr Lorenzo.

In this video,  the doc is doing the implantation and each slit/graft stick is taking more time, plus he has to switch tools each time

It looks like the doc from the top video can easily do 3 incisions during the time it takes to do just 1 implanter pen graft placement, so multiply this by 2000 or 3000 and you can quickly see why a single doc will not be able to use DHI  as method  to operate on a multitude of patients in one afternoon.

I can confirm it takes much longer to implant with implanter pen having it done first hand. Although I must admit it depends on the skill of the surgeon. Dr. Lorenzo is quite fast at this point.