Dr. Ron Shapiro Side By Side Study FUT and FUE Lifetime Grafts

[Melvin- Admin]

After speaking with Dr. Konior and Dr. Nadimi this weekend, Dr. Konior mentioned a study conducted by Dr. Ron Shapiro, an elite surgeon who actually kick started this community by performing surgery on @Pat - Community Publisher the study concludes that patients who start off with FUT first and combine FUE get more lifetime grafts than either technique alone. I thought it was pretty interesting, especially for those interested in maximizing donor supply.

 

https://www.ishrs-htforum.org/content/htfi/29/5/local/front-matter.pdf

[Mycroft]

I think it's interesting that strips of approximately 3k grafts are recommended as the upper limit to promote the highest chance of favorable scarring. I wonder if this recommendation would be lowered on subsequent strip procedures once scalp laxity has been compromised by a surgery.

 

[Melvin- Admin]

3 minutes ago, Mycroft said:

I think it's interesting that strips of approximately 3k grafts are recommended as the upper limit to promote the highest chance of favorable scarring. I wonder if this recommendation would be lowered on subsequent strip procedures once scalp laxity has been compromised by a surgery.

 

That's a great question, I may reach out to Dr. Ron Shapiro @Dr. Ron Shapiro to get his input. He really is such a talented surgeon, there haven't been any studies on this scale done before. 

[aaron1234]

The conclusion of this study makes complete sense to me.  The difference will be that some patients get more out of FUT than FUE, or vice versa, depending on their scalp elasticity and donor density. 

[Melvin- Admin]

19 minutes ago, aaron1234 said:

The conclusion of this study makes complete sense to me.  The difference will be that some patients get more out of FUT than FUE, or vice versa, depending on their scalp elasticity and donor density. 

I agree, it’s common sense really, but there’s still a lot of guys who think FUT is barbaric or outdated, flat out wrong.

[OliverAtom]

21 hours ago, aaron1234 said:

The conclusion of this study makes complete sense to me.  The difference will be that some patients get more out of FUT than FUE, or vice versa, depending on their scalp elasticity and donor density. 

Totally agree with this. It all depends on the patient needs and possibilities.

[1978matt]

The more detailed article here:

https://www.ishrs-htforum.org/content/28/5/179

[Melvin- Admin]

8 hours ago, 1978matt said:

The more detailed article here:

https://www.ishrs-htforum.org/content/28/5/179

Thank you Matt, I’ll update it he article in YouTube as well.

[olmert]

The conclusion that Dr. Shapiro gives makes no sense. 

He did not give an FUT/FUE combo to any patient. He gave one or the other, and found the result was similar. Where does he get the data to support that the combo is better?

Edited February 23, 2021 by olmert

[SLA]

5 hours ago, olmert said:

The conclusion that Dr. Shapiro gives makes no sense. 

He did not give an FUT/FUE combo to any patient. He gave one or the other, and found the result was similar. Where does he get the data to support that the combo is better?

The article you likely read posted above https://www.ishrs-htforum.org/content/28/5/179 was not the study of total number of lifetime grafts, but rather which technique had a better survival rate.

This article https://www.ishrs-htforum.org/content/htfi/29/5/local/front-matter.pdf is a 1-page synopsis on the lifetime graft potential, however, it does not provide detail of the study.

 

 

[olmert]

Shapiro is exaggerating when gauged by medical convention. He says he did not test combo FUT/FUE.  He only infers combo would yield more, while hiding in fuzzy language that is never used in medical literature. He is ridiculously vague. His implication is that more residual hair was left with FUT at the donor site.

“A side-by-side study was done in which two patients had FUE only harvested from one side (half) of the head, and FUT only from the other side (half). This “side by side” harvesting was done two times one year apart. The number of hair (grafts) obtained per technique on each side (after two sessions) was recorded along with the “residual hair” density on both sides. From this data, the total amount of hair that FUE only, FUT only, and Combination FUT/FUE could potentially obtain. . . . Conclusion: More hair and grafts were obtained using combination FUT followed by FUE than by either technique alone.”

Shapiro is de-emphasizing that he is inferring “potential” based upon residual hair at the donor spot. Why does he use the word "were obtained" by Combo if he says he didn't do any combo?

Edited February 23, 2021 by olmert

[asterix0]

@olmert what do you suspect the true number of available lifetime grafts is for fue only vs fut+fue? Due to the immedietly adjacent grafts around the fut scar site being more vulnerable and potentially unusable for future fue, I think it is less than this 3000 estimate spoken around the forum. I was more leaning towards 1000-1500.

[Melvin- Admin]

1 hour ago, asterix0 said:

@olmert what do you suspect the true number of available lifetime grafts is for fue only vs fut+fue? Due to the immedietly adjacent grafts around the fut scar site being more vulnerable and potentially unusable for future fue, I think it is less than this 3000 estimate spoken around the forum. I was more leaning towards 1000-1500.

It depends on the person, on average you can get around 5k FUE grafts without issues. Some can get 8,000 some even 10,000 of course those are outliers.

[olmert]

Do most doctors currently believe you can get more lifetime grafts by first doing FUT until you can't anymore and then FUE? About how many more lifetime grafts on average? 

I think most patients' goal is maximizing lifetime grafts. (If this is not your goal, you probably don't even need one transplant.) So why are there so many doctors who only do FUE?

The data is all the counts, but I am having a hard time envisioning why you would get more lifetime grafts with a FUT/FUE combo than with FUE alone. It used to be that more donors survive with FUT after being implanted, but this is no longer so. So why can you yank out more lifetime donor grafts with the combo? 

[SLA]

10 hours ago, olmert said:

Do most doctors currently believe you can get more lifetime grafts by first doing FUT until you can't anymore and then FUE? About how many more lifetime grafts on average? 

I think most patients' goal is maximizing lifetime grafts. (If this is not your goal, you probably don't even need one transplant.) So why are there so many doctors who only do FUE?

The data is all the counts, but I am having a hard time envisioning why you would get more lifetime grafts with a FUT/FUE combo than with FUE alone. It used to be that more donors survive with FUT after being implanted, but this is no longer so. So why can you yank out more lifetime donor grafts with the combo? 

So I think the logic is that with FUT you are actually removing the entire strip of skin and can transplant ALL of the hair follicles rather than with FUE in which you are extracting only 1 of every 4 hairs or so from that same region. So in theory, if you do a series of FUT in which you are removing strip after strip of skin and transplanting ALL of those follicles followed by FUE to get even more follicle you can get more grafts.

HOWEVER, not all surgeons agree with this. Some of these arguments are coming from very reputable surgeons who used to perform FUT and left that behind. Through my research, the counter arguments range as follows:

1. If you do an FUT, you need to leave hair to hide the linear scar, so you wouldn't be able to extract as much with FUE in subsequent procedures

2. FUT alters the direction of hair growth making it more difficult to extract afterwards with FUE

3. When you perform FUT, the skin stretches which causes a downward displacement of the crown expanding the area of baldness, so the extra follicles you might obtain from an FUT strip is negated by the expanded area of baldness in the crown you must now cover

4. You inevitably transect follicle when you cut the FUT strip

5. When FUT is performed, hair in the growth and telogen phase is often not found and/or hard to extract and is discarded or transected, but with FUE, you can select hairs

6. If a follicle is transected while dissecting the strip, it is unusable, but if transected with FUE it can remain in vivo for future use

7. You can always get more GRAFTS with FUT as there is subdivision which takes place when dissecting. For instance one grouping with 4 hairs can be divided into 2 groups of 2

8. FUT transplants can create more donor thinning below the strip scar making those follicle unextractable (or more difficult to extract) by FUE. A top surgeon well respected on this forum sent me photos of this from actual patients

9. Hairs not in proper phase may not survive the dissection

Please note, I am NOT advocating for either side of the argument, but rather just educating on what I learned. I don't what the true answer is and would love to see further studies and debates from surgeons on both sides of the table.

Hope this helps :)!

[olmert]

5 minutes ago, SLA said:

So I think the logic is that with FUT you are actually removing the entire strip of skin and can transplant ALL of the hair follicles rather than with FUE in which you are extracting only 1 of every 4 hairs or so from that same region. So in theory, if you do a series of FUT in which you are removing strip after strip of skin and transplanting ALL of those follicles followed by FUE to get even more follicle you can get more grafts.

So give me a sense of what you think the approximate numbers are. Do 50% of doctors think you will get more lifetime grafts from an FUT/FUE combo, while 50% think you will get more from FUE alone? Do they also basically think that the lifetime grafts won't vary by more than 5% depending upon which you choose? What percent more are they making claims about? 

[SLA]

I do not know percentages. I think at this point, most reputable North American surgeons who perform both techniques would probably recommend FUT for advanced or destined to be advanced hair loss and doing as many FUTs as you can before switching over to FUE so I think there are probably more in the FUT/FUE camp. I think Hasson and Wong says you can get 1-2k grafts which could be up to 20% more with FUT/FUE combo. 

[kramer79]

1 hour ago, SLA said:

HOWEVER, not all surgeons agree with this. Some of these arguments are coming from very reputable surgeons who used to perform FUT and left that behind.

Can you mention the surgeons who made these arguments? I simply ask because I think there is essence in who is making the statements.

Speaking to Dr. Wong, he had mentioned that starting with FUT and going to FUE after would yield up to 2000-3000 grafts extra.

Dr. Konior also seems to share the opinion that FUT+FUE yields more grafts as well.

There is only so much FUE that can be done exclusively before the donor region starts to look depleted/thin.

[SLA]

1 hour ago, kramer79 said:

Can you mention the surgeons who made these arguments? I simply ask because I think there is essence in who is making the statements.

Speaking to Dr. Wong, he had mentioned that starting with FUT and going to FUE after would yield up to 2000-3000 grafts extra.

Dr. Konior also seems to share the opinion that FUT+FUE yields more grafts as well.

There is only so much FUE that can be done exclusively before the donor region starts to look depleted/thin.

Sure....

Dr. Arika Bansal (Eugenix)- She is a coalition doctor on this site who left FUT. Saw it in an interview with Joe Tillman and through a virtual consultation with me. She also sent me the photos of donor thinning below an FUT scar as referenced above

John P Cole- The inventor of the Cole punch used worldwide. He left FUT over 15 years ago and claims to have performed more than 8k FUT procedures. I emailed him and he specifically said someone with advanced hair loss should not consider FUT. I posted an article in the FUE forum titled 'The Case for FUE' in which he details his argument

Dr. Bhatti- You can go to the Darling Buds website to learn more about his stance. He used to be a coalition surgeon on this site.

Dr. Vories- A coalition doctor on this site. I had an email dialogue about this specific question through his representative John Casper.

Again, please note I am not arguing either position as I don't have the knowledge to do this :). 

[Melvin- Admin]

On 2/23/2021 at 6:40 AM, olmert said:

Shapiro is exaggerating when gauged by medical convention. He says he did not test combo FUT/FUE.  He only infers combo would yield more, while hiding in fuzzy language that is never used in medical literature. He is ridiculously vague. His implication is that more residual hair was left with FUT at the donor site.

“A side-by-side study was done in which two patients had FUE only harvested from one side (half) of the head, and FUT only from the other side (half). This “side by side” harvesting was done two times one year apart. The number of hair (grafts) obtained per technique on each side (after two sessions) was recorded along with the “residual hair” density on both sides. From this data, the total amount of hair that FUE only, FUT only, and Combination FUT/FUE could potentially obtain. . . . Conclusion: More hair and grafts were obtained using combination FUT followed by FUE than by either technique alone.”

Shapiro is de-emphasizing that he is inferring “potential” based upon residual hair at the donor spot. Why does he use the word "were obtained" by Combo if he says he didn't do any combo?

It’s common sense. Combining both would get all of the viable hair in your donor. 

[Melvin- Admin]

4 hours ago, SLA said:

Sure....

Dr. Arika Bansal (Eugenix)- She is a coalition doctor on this site who left FUT. Saw it in an interview with Joe Tillman and through a virtual consultation with me. She also sent me the photos of donor thinning below an FUT scar as referenced above

John P Cole- The inventor of the Cole punch used worldwide. He left FUT over 15 years ago and claims to have performed more than 8k FUT procedures. I emailed him and he specifically said someone with advanced hair loss should not consider FUT. I posted an article in the FUE forum titled 'The Case for FUE' in which he details his argument

Dr. Bhatti- You can go to the Darling Buds website to learn more about his stance. He used to be a coalition surgeon on this site.

Dr. Vories- A coalition doctor on this site. I had an email dialogue about this specific question through his representative John Casper.

Again, please note I am not arguing either position as I don't have the knowledge to do this :). 

Bhatti was never on the Coalition, he was removed last year from our recommendations.

[olmert]

3 hours ago, Melvin-Moderator said:

It’s common sense. Combining both would get all of the viable hair in your donor. 

Can you give a rough, unscientific estimate of how many more grafts it is generally believed you can get from combo?  Are we talking 1,000 more grafts total on average?

Also at what point do people generally stop getting FUT and move to FUE? Four FUT's and then to FUE? Is that decision made more by how many grafts another FUT can get, for instance once FUT can only get 1300 grafts, people generally go to FUE? 

[aaron1234]

1 hour ago, olmert said:

Also at what point do people generally stop getting FUT and move to FUE? Four FUT's and then to FUE? Is that decision made more by how many grafts another FUT can get, for instance once FUT can only get 1300 grafts, people generally go to FUE? 

For me it was 6 FUT's before FUE.  It could have been 4, it becomes a judgement call at a certain point.  It's all detailed in my recent post.  I will definitely achieve more lifetime grafts with the FUT/FUE combo approach, no question.  

 

[SLA]

15 hours ago, Melvin-Moderator said:

Bhatti was never on the Coalition, he was removed last year from our recommendations.

My bad....I didn't realize 'coalition' and 'recommended' were two different categories.

[SLA]

15 hours ago, Melvin-Moderator said:

It’s common sense. Combining both would get all of the viable hair in your donor. 

It seems like common sense @Melvin-Moderatorhowever, for the reasons laid out above, not all doctors seem to agree and their points seem like they could have validity, no?