FUE has same or higher survival rate than FUT?

[Rolandas]

Most of you probably heard that FUT has higher survival rate.. But is it?

I found one study that shows otherwise! Imagine, they cut FUT strip on the right side of his donor, and FUE punches on the left side O_O

Of course it all depends who is doing your surgery, so don't jump into conclusions too early! What do you think?

Btw here's the study https://www.ishrs-htforum.org/content/28/5/179

 

[1978matt]

I believe this was the Shapiro study from 2 or 3 years ago.

One thing that occured to me is that the FUE surgeon gets to choose which grafts he takes versus FUT where you use whatever is in the strip.  Therefore, the FUE could select a greater proportion of stronger looking (less miniaturised) hairs, even if they were restricted to the same numbers of 1,2,3 & 4 hair grafts.

Perhaps that is one factor which led to slightly better growth.

[Rolandas]

4 minutes ago, 1978matt said:

I believe this was the Shapiro study from 2 or 3 years ago.

One thing that occured to me is that the FUE surgeon gets to choose which grafts he takes versus FUT where you use whatever is in the strip.  Therefore, the FUE could select a greater proportion of stronger looking (less miniaturised) hairs, even if they were restricted to the same numbers of 1,2,3 & 4 hair grafts.

Perhaps that is one factor which led to slightly better growth.

But this is the reason why fue might be superior technique than fut right?

Of course if someone is NW6/7, then definitely FUT will be the way to go regardless of survival. Donor management is still they key.

[JohnBob]

Thank you for attacking one of the biggest dogmas of the HT field, the FUT yields more/harvests better than FUE. 

It seems like it's much more dependable on the skills and tools of the doctor than to the procedures itself. 

[JohnBob]

For example, this is a single session 9000+ graft restoration by Dr. Hasson

 

 

Look how wide the strip was. How many follicles were transected because they were in the way of two horizontal incisions, and also in the area of the stitches?

Probably more than a thousand? Nobody talks about that. With FUE you don't have that problem (if the surgeon is good). 

Edited November 27, 2020 by JohnBob

[JohnBob]

1 hour ago, Rolandas said:

 

Of course if someone is NW6/7, then definitely FUT will be the way to go regardless of survival. Donor management is still they key.

Why? Why taking FUs in bulk is better for your donor than taking each FU individually?

Edited November 26, 2020 by JohnBob

[Rolandas]

10 minutes ago, JohnBob said:

Why? Why taking FUs in bulk is better for your donor than taking each FU individually?

You brought up really good points on FUT stitches causing transection of surrounding grafts. Never heard much about it to be honest, but it's an interesting theory.

Imagine someone NW7, he has very thin donor area. How many grafts would be safe to extract in one surgery? 2000? The patient would need to get 3 surgeries to get only 6000 grafts (considering donor management while extracting was spot on). There would be still chances of permanent shock loss. There are no guarantees it won't happen even in best hands.
6000 grafts on NW7 is good, but not enough. 6k grafts could have been extracted in 1 strip. Of course chances of shock loss are there too with fut, but overall chances are smaller as the patient would have only 1 surgery as opposed to 3.

Of course all these numbers are just random, but hope this show my though process.

[JohnBob]

3 hours ago, Rolandas said:

You brought up really good points on FUT stitches causing transection of surrounding grafts. Never heard much about it to be honest, but it's an interesting theory.

Imagine someone NW7, he has very thin donor area. How many grafts would be safe to extract in one surgery? 2000? The patient would need to get 3 surgeries to get only 6000 grafts (considering donor management while extracting was spot on). There would be still chances of permanent shock loss. There are no guarantees it won't happen even in best hands.
6000 grafts on NW7 is good, but not enough. 6k grafts could have been extracted in 1 strip. Of course chances of shock loss are there too with fut, but overall chances are smaller as the patient would have only 1 surgery as opposed to 3.

Of course all these numbers are just random, but hope this show my though process.

Not only stitches, but the strip means you make two huge horizontal cuts that will for sure damage a lot surrounding FUs too. I wonder why that's never talked about? 

Your though process makes sense, but I would like to question the premise being used. Why is the consensus that you can't extract a high number of FUs via FUE (2000 in your example)? Too many tiny little scars all over the scalp can damage the skin and cause shock loss? This is an assumption that has been thrown without much scientific evidence IMO.

 

Doctors like Zarev are pushing the limits of what can be done with FUE and are harvesting 10,000+ follicles while keeping the donor aesthetically good. So the dogma that FUT is better than FUE for high numbers of donor harvesting should be challenged. 

Edited November 27, 2020 by JohnBob

[HTP1]

4 hours ago, JohnBob said:

Why? Why taking FUs in bulk is better for your donor than taking each FU individually?

Because you'd create over 9000 individual scars that have a much larger surface area of scar tissue than the FUT scar and have a significant risk of FUE overharvesting. That as opposed to using up skin elasticity and creating a relatively small linear scar. 

Edited November 27, 2020 by HTP1

[1978matt]

11 hours ago, Rolandas said:

But this is the reason why fue might be superior technique than fut right?

Of course if someone is NW6/7, then definitely FUT will be the way to go regardless of survival. Donor management is still they key.

I don't think you can say one is better than the other.  One might be better for one person versus another, based on their personal situation.

Having had both I would still go FUT if I had my time over again.

In my case I had about 8000 hairs from FUT and 5000 from FUE.  There's quite a bit of density loss in the donor from the FUE, and I can't imagine what it would look like if I had taken 13000 hairs from just FUE.

[Rolandas]

6 hours ago, JohnBob said:

Not only stitches, but the strip means you make two huge horizontal cuts that will for sure damage a lot surrounding FUs too. I wonder why that's never talked about? 

Your though process makes sense, but I would like to question the premise being used. Why is the consensus that you can't extract a high number of FUs via FUE (2000 in your example)? Too many tiny little scars all over the scalp can damage the skin and cause shock loss? This is an assumption that has been thrown without much scientific evidence IMO.

 

Doctors like Zarev are pushing the limits of what can be done with FUE and are harvesting 10,000+ follicles while keeping the donor aesthetically good. So the dogma that FUT is better than FUE for high numbers of donor harvesting should be challenged. 

Don't buy into Dr. Zarev hype. He is one of the best surgeons, but it doesn't mean he consistently does 10,000 fue. It all depends on donor characteristics and if one has very high average hair per graft ratio, then of course it's easier to get more grafts in single session.
Also let's not forget hair loss pattern. I was referring to NW7 where relatively small donor area is available. Since FUE requires to spread it out to extract more grafts in single session, this sets huge limits.

Besides, Dr. Zarev is doing multiple fue sessions as well. If I recall his biggest is something around 7k grafts in single surgical session, which still is mind boggling, but to be fair, he is using very wide extraction area on NW5 or so with perfect donor conditions.

And yes, shock loss is the biggest factor. Not sure why you need scientific evidence of it. It's happening consistently in shit cheap clinics. Extractions are done too close causing shock loss.

Of course let's not forget how long such surgeries will take. I had 3659 grafts in 1 surgery over 2 days. Surgery lasted full day from 7:30am to 5:30 pm. I wouldn't like my surgeon to get 6000 grafts via FUE in one go and later to discover that most of it didn't take. Much safer approach with smaller surgeries.

[JohnBob]

9 hours ago, HTP1 said:

Because you'd create over 9000 individual scars that have a much larger surface area of scar tissue than the FUT scar and have a significant risk of FUE overharvesting. That as opposed to using up skin elasticity and creating a relatively small linear scar. 

If those scars don't affect the adjacent follicles and the extractions are done in spread out pattern, then why it is a problem?

Edited November 27, 2020 by JohnBob

[JohnBob]

4 hours ago, Rolandas said:

And yes, shock loss is the biggest factor. Not sure why you need scientific evidence of it. It's happening consistently in shit cheap clinics. Extractions are done too close causing shock loss.

 

So then it's shit cheap clinics fault, not a problem with the method itself, no?

I assume shitty clinics botch FUT procedures too so that's not a fair comparison. 

[Storyteller]

11 hours ago, JohnBob said:

Doctors like Zarev are pushing the limits of what can be done with FUE and are harvesting 10,000+ follicles while keeping the donor aesthetically good. So the dogma that FUT is better than FUE for high numbers of donor harvesting should be challenged. 

His results look wonderful and impressive,but...

Nobody can be sure what these people will look like in 10 or 15 years from now.As we all know hairloss is an ongoing process that never stops.

Given that fact,extracting such a massive number of grafts via fue can only mean one thing :that the extraction took place out of the safe area.Which means that many of these grafts will not survive in the long term.

If a donor area can give ,lets say 7500 grafts via fue ,they should not be taken all in one procedure,but in smaller ones.Each procedure should give not more than 2500 grafts.That means 3 small procedures and before each one the donor area will certainly need to be reassessed.Things are different with strip,which is the only proven method that can justify the extraction of high number of grafts all in once without running the risk of losing some of them in the future.

Fut will always outweigh fue when it comes to the number of grafts that can be harvested in one session,and of course the combination of fut and fue will always be better than each method alone is.

 

Edited November 27, 2020 by Storyteller

[Louisjams]

Single operator studies have low reproducibility and are of lesser value. 

[JohnBob]

49 minutes ago, Storyteller said:

If a donor area can give ,lets say 7500 grafts via fue ,they should not be taken all in one procedure,but in smaller ones.Each procedure should give not more than 2500 grafts.That means 3 small procedures and before each one the donor area will certainly need to be reassessed.Things are different with strip,which is the only proven method that can justify the extraction of high number of grafts all in once without running the risk of losing some of them in the future.

Fut will always outweigh fue when it comes to the number of grafts that can be harvested in one session,and of course the combination of fut and fue will always be better than each method alone is.

 

Proven how exactly? I don't mean to sound harsh but I get the impression that we repeat "truths" without actually thinking what's the basis of them. 

Sure, FUE is a much complex procedure so it would be very hard to competently extract 9,000 grafts in a single day, probably impossible with current tools. But good doctors can spread it between two consecutive days with no apparent problem. 

Also why nobody talks about the donor hairs lost because FUT strip cuts, stitches and scars? How many hairs are lost there? With FUE we don't have that problem. 

[aaron1234]

5 hours ago, 1978matt said:

I don't think you can say one is better than the other.  One might be better for one person versus another, based on their personal situation.

Having had both I would still go FUT if I had my time over again.

In my case I had about 8000 hairs from FUT and 5000 from FUE.  There's quite a bit of density loss in the donor from the FUE, and I can't imagine what it would look like if I had taken 13000 hairs from just FUE.

💯 This!  I had five strip surgeries (plus one scar reduction) before I ventured into FUE.  I needed every graft and then some.  I will say that I'm glad FUE's yield rates have drastically improved over the past decade.  Arguments about the viability of FUE grafts really dominated the forum back in the day.

[HTP1]

1 hour ago, JohnBob said:

If those scars don't affect the adjacent follicles and the extractions are done in spread out pattern, then why it is a problem?

Because too FU are taken so the area is overharvested because there isn't enough remaining hair to cover the missing ones up / scars up. 

How do you think FUE overharvesting happens? 

Edited November 27, 2020 by HTP1

[JohnBob]

27 minutes ago, HTP1 said:

Because too FU are taken so the area is overharvested because there isn't enough remaining hair to cover the missing ones up / scars up. 

How do you think FUE overharvesting happens? 

I may be missing something, but "the area is over harvested because too FU are taken" reads like a circular explanation to me.

Hence, if you take too much FUs via FUT the donor area will be over harvested too. 

 

[HTP1]

1 hour ago, JohnBob said:

I may be missing something, but "the area is over harvested because too FU are taken" reads like a circular explanation to me.

Hence, if you take too much FUs via FUT the donor area will be over harvested too. 

 

It should read 'too many FU are taken'. 

Think what happens with FUT. The area of skin where the FUs are taken from is removed from the scalp in exchange for some scalp laxity. The question is then how neat the scar will be. Whether 1000 or 9000 are taken, the question is around the scar. The remaining hair on the scalp is untouched and can easily cover up the FUT scar, even with larger surgeries. 

With FUE the area of skin where the FUs are taken is still there on the scalp, and if you take too many there aren't enough remaining to cover the ones which were taken. 

Google 'FUE over-harvesting' and you'll see the thinning I am referring to, 

Edited to add a fine example. 
 

Edited November 27, 2020 by HTP1

[1978matt]

3 hours ago, JohnBob said:

Also why nobody talks about the donor hairs lost because FUT strip cuts, stitches and scars? How many hairs are lost there? With FUE we don't have that problem. 

You know, FUE extraction is not perfect either.  Grafts can can be sliced through just as easily as with neither method can the doctor see exactly what is going on below the surface.

You can make an estimate of the maximum number of grafts 'cut through' on an FUT, and it goes as follows:

80 grafts per sq cm with 2.2 hairs each = 176 hairs/cm2

The square root of 176 is about 13.  So there are 13 hairs on any side of a 1cm square of scalp.

A strip is typically 30cm long, so do 30 x 2 x 13 = 800 hairs

But, not all will be damaged, so lets say 50% are.  So 400 'hairs' are lost.

Converting this back to grafts, divide by 2.2 = 181 grafts damaged.

So out of a 3000 graft FUT you only lose about 6% of grafts during strip excision.

 

[1978matt]

Oh and with sutures, the main problem is to do with excess tension which cuts off blood supply and results in the 'train track' appearance.  Top doctors know not to do that.

[asterix0]

Hypothetically, in the hands of the best hair transplant surgeon in the world, I believe FUE is the superior procedure. 

In theory:

• FUE should allow for more available lifetime grafts, and to cherry pick the best grafts to put them in the optimal positions. There is more surface area available for FUE grafts to be taken from. 
• FUE is the less invasive procedure and there is less risk for nerve damage, prolonged numbness, etc.
• FUE allows for greater flexibility of haircuts in the future.

Of course, many surgeons who are not the best of the best will give you more scarring via FUE, less available grafts because of high transection and blowing away your donor, and you will be paying more to get a bad result.

 

[gillenator]

It really does come down to the skill of the surgical team, both the surgeon and the techs.

[JohnBob]

3 hours ago, HTP1 said:

It should read 'too many FU are taken'. 

Think what happens with FUT. The area of skin where the FUs are taken from is removed from the scalp in exchange for some scalp laxity. The question is then how neat the scar will be. Whether 1000 or 9000 are taken, the question is around the scar. The remaining hair on the scalp is untouched and can easily cover up the FUT scar, even with larger surgeries. 

With FUE the area of skin where the FUs are taken is still there on the scalp, and if you take too many there aren't enough remaining to cover the ones which were taken. 

Google 'FUE over-harvesting' and you'll see the thinning I am referring to, 

Edited to add a fine example. 
 

True. However the same problem (too many grafts and/or bad technique) can happen with FUT too:

 

Edited November 27, 2020 by JohnBob