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

[olmert]

40 minutes ago, SLA said:

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?

 

But the posts above give the impression that 90% of doctors think combo will yield radically more lifetime grafts, like 2,000 more. 

This website always favored FUT over FUE. I wonder if the doctors favoring FUT somehow ended up here, or if legitimately 90% of the general experienced doctor pool believes the combo yields 2,000 more lifetime grafts. 

 

[SLA]

40 minutes ago, olmert said:

But the posts above give the impression that 90% of doctors think combo will yield radically more lifetime grafts, like 2,000 more. 

This website always favored FUT over FUE. I wonder if the doctors favoring FUT somehow ended up here, or if legitimately 90% of the general experienced doctor pool believes the combo yields 2,000 more lifetime grafts. 

 

I feel your frustration @olmert. It would be great if we could narrow down on an absolute regarding this issue and the best we have to go on is the Shapiro study. Does one study prove an absolute? No. Could the methodology have been off? For sure- my wife is a neuroscientist and knows all about methodological issue with studies. Has this study been replicated? Was it double blind? No. Could it be biased? Maybe. Could they not have taken all things into account? Sure

Some FUE doctors claim doctors who perform FUT as favoring this technique because it takes WAY less time for the surgeon to perform. Could this be true? Perhaps.

Could FUE doctors claiming FUE alone can yield more grafts than the combined FUT/FUE be biased? For sure!

As I mentioned above, you can read the article I posted in the FUE forum titled, 'The Case for FUE' and re-read the 9 FUE counterarguments I detailed earlier in this post and you will have to come to your own conclusions.

What would prove more of an absolute for me is for there to be several studies performed to test this hypothesis which all point to the same conclusion. 

Until then, you will just have to go with this and trust your gut.

[Melvin- Admin]

1 hour ago, olmert said:

But the posts above give the impression that 90% of doctors think combo will yield radically more lifetime grafts, like 2,000 more. 

This website always favored FUT over FUE. I wonder if the doctors favoring FUT somehow ended up here, or if legitimately 90% of the general experienced doctor pool believes the combo yields 2,000 more lifetime grafts. 

 

What are you taking about, it’s quite the opposite did you see the interview? 

 

[olmert]

So when they take hair out for FUE, they don't take from the FUT donor region? I remember reading years back not to do FUE before FUT because the FUE would take hairs from the strip region, and then the strip would have fewer hairs. 

[Melvin- Admin]

10 hours ago, olmert said:

But the posts above give the impression that 90% of doctors think combo will yield radically more lifetime grafts, like 2,000 more. 

This website always favored FUT over FUE. I wonder if the doctors favoring FUT somehow ended up here, or if legitimately 90% of the general experienced doctor pool believes the combo yields 2,000 more lifetime grafts. 

 

That’s because it will. It’s common knowledge that using both methods yields more hair, how much is debatable, but I personally feel a minimum of 1,000 grafts extra.

[nicoandgello]

8 minutes ago, Melvin-Moderator said:

That’s because it will. It’s common knowledge that using both methods yields more hair, how much is debatable, but I personally feel a minimum of 1,000 grafts extra.

That just makes me question why dr Zarev uses only FUE. His patients need to have long hair after surgery anyway, because donor with over 10000 grafts used would look bad with short cut. Do you think he just cant use FUT?

[Melvin- Admin]

Just now, nicoandgello said:

That just makes me question why dr Zarev uses only FUE. His patients need to have long hair after surgery anyway, because donor with over 10000 grafts used would look bad with short cut. Do you think he just cant use FUT?

In order to perform FUT you need to have a team of technicians who can sliver and dissect the grafts. If you perform large FUT's like Hasson and Wong you need to have an even bigger team and they need to have a lot of experience. I don't think there are that many people as experienced in Europe, especially now. It's just easier to find a team that are proficient at FUE in Europe.

[olmert]

13 hours ago, Melvin-Moderator said:

What are you taking about, it’s quite the opposite did you see the interview? 

 

But I don't understand. Why does the video say it does not matter whether you get FUT or FUE first? Why are there old posts on this forum that say you should do the FUT first, that say if you do FUE first, then the strip will simply have fewer grafts on it because they were plucked out from the FUE?

 

 

[SLA]

8 hours ago, olmert said:

But I don't understand. Why does the video say it does not matter whether you get FUT or FUE first? Why are there old posts on this forum that say you should do the FUT first, that say if you do FUE first, then the strip will simply have fewer grafts on it because they were plucked out from the FUE?

 

 

You can have FUE 1st, but that being said, if you do FUT afterwards there will be fewer hairs in the strip because some were already extracted from that area via FUE. What I believe one needs to be mindful of is extracting too many grafts via FUE 1st as the donor area will thinner and one will not have any residual hair to hide a strip scar.

In the webinar with Ron Shapiro, he made a comment about not exceeding 4k grafts with FUE if one wanted to do FUT afterwards. 4k is probably an estimate and depends on the individual and donor region.

 

[olmert]

7 minutes ago, SLA said:

In the webinar with Ron Shapiro, he made a comment about not exceeding 4k grafts with FUE if one wanted to do FUT afterwards. 4k is probably an estimate and depends on the individual and donor region.

But you are saying you would be a fool to do even one FUE graft first and then after take out a strip with a hole punched in it. You say to do the FUT before even one FUE.

So why does the webinar say it does not matter which one you do first: a 4,000 graft FUE or an FUT?  Why would you want the FUT strip to have even one hole punched in it? 

Edited February 26, 2021 by olmert

[Melvin- Admin]

11 hours ago, olmert said:

But I don't understand. Why does the video say it does not matter whether you get FUT or FUE first? Why are there old posts on this forum that say you should do the FUT first, that say if you do FUE first, then the strip will simply have fewer grafts on it because they were plucked out from the FUE?

 

 

That is what is debatable, it was always thought that you should FUT first, but Shapiro thinks you can FUE first as long as it’s under 3000 grafts. 

[SLA]

3 hours ago, olmert said:

But you are saying you would be a fool to do even one FUE graft first and then after take out a strip with a hole punched in it. You say to do the FUT before even one FUE.

So why does the webinar say it does not matter which one you do first: a 4,000 graft FUE or an FUT?  Why would you want the FUT strip to have even one hole punched in it? 

I am not saying that. If you do FUE 1st the FUT strip will inevitably have less yield, but those grafts that are missing from the strip have already been extracted via FUE and placed in the recipient area. So you are getting all the grafts from the FUT strip, but some had already been extracted and implanted 1st via FUE.

[SLA]

2 minutes ago, Melvin-Moderator said:

That is what is debatable, it was always thought that you should FUT first, but Shapiro thinks you can FUE first as long as it’s under 3000 grafts. 

True @Melvin-Moderator. I am pretty sure Shapiro actually said not to exceed 4k FUE grafts (rather than 3k). Josephitis was clear in saying he felt that lifetime there are ~3k grafts available trough both methods.

[olmert]

20 minutes ago, Melvin-Moderator said:

That is what is debatable, it was always thought that you should FUT first, but Shapiro thinks you can FUE first as long as it’s under 3000 grafts. 

But why a 3K or 4K limit? According to SLA, you won't lose lifetime grafts with FUE before FUT. You will first punch out the grafts in FUE. Then you will take a strip with holes. No loss, he says. 

[Melvin- Admin]

40 minutes ago, olmert said:

But why a 3K or 4K limit? According to SLA, you won't lose lifetime grafts with FUE before FUT. You will first punch out the grafts in FUE. Then you will take a strip with holes. No loss, he says. 

Well, FUE decreases overall density, so if you do get an FUT after extracting 6-7k grafts, the scar will be a lot more visible. It’s possible, yes, but not advisable.

[mtb]

On 2/26/2021 at 11:18 AM, SLA said:

I am not saying that. If you do FUE 1st the FUT strip will inevitably have less yield, but those grafts that are missing from the strip have already been extracted via FUE and placed in the recipient area. So you are getting all the grafts from the FUT strip, but some had already been extracted and implanted 1st via FUE.

This makes sense to me. After reading dozens of posts and websites I don't understand the logic of why you would get less total grafts moved if you did FUE before FUT (but that seems to be what the majority of posters believe).

For example, let's say you had an FUE procedure of 4,000 grafts and 1,500 of the 4,000 happened to be extracted in the area that would be considered the FUT donor area. Then, years later, when you get around to doing the FUT procedure in the future that FUT procedure donor area would have 1,500 less available grafts. However those 1,500 grafts that are missing out of the FUT donor area are already on the top of your head. So it seems like in terms of total graft count that is able to be moved the numbers are the same.

Is there something that I'm missing? Can someone please educate me? After much research I'm deciding between a clinic that provides FUE only (6000 grafts scalp and beard quoted) and another clinic that is recommending a combine FUT/FUE for me (4800 scalp grafts quoted). I'm a Norwood 5/6. @SLA   @Melvin- Moderator

[olmert]

1 hour ago, mtb said:

Can someone please educate me? After much research I'm deciding between a clinic that provides FUE only (6000 grafts scalp and beard quoted) and another clinic that is recommending a combine FUT/FUE for me (4800 scalp grafts quoted). I'm a Norwood 5/6. @SLA   @Melvin- Moderator

Under your logic, FUE alone should be able to get as many grafts as an FUE/FUT combo. Every corner that FUT can reach, can be reached also by FUE. So why should the combo get you more than FUE alone? 

FUT alone cannot max you out because there are corners that FUE can reach that a strip could not reach. 

The obvious answer is that getting the same graft from FUT (instead of FUE) is better.  Maybe even today the survival rate is higher with FUT. The moderator says the combo can get you much more than FUE alone.

[mtb]

16 hours ago, olmert said:

Under your logic, FUE alone should be able to get as many grafts as an FUE/FUT combo. Every corner that FUT can reach, can be reached also by FUE. So why should the combo get you more than FUE alone? 

FUT alone cannot max you out because there are corners that FUE can reach that a strip could not reach. 

The obvious answer is that getting the same graft from FUT (instead of FUE) is better.  Maybe even today the survival rate is higher with FUT. The moderator says the combo can get you much more than FUE alone.

Yes, I understand why the FUT/FUE combo would yield more grafts than FUE alone.

I do not understand why doing FUE before FUT would yield less grafts than FUT before FUE. 

[aaron1234]

8 hours ago, mtb said:

I do not understand why doing FUE before FUT would yield less grafts than FUT before FUE. 

A strip excision gets every graft within its parameters.  Within that same "strip" zone, FUE wouldn't come close to those numbers without leaving it bare.  It's why the donor regions of patients who've had 6,000 grafts via FUE look far less dense than the donor regions of patients who have 6,000 grafts via FUT.  

[olmert]

36 minutes ago, aaron1234 said:

A strip excision gets every graft within its parameters.  Within that same "strip" zone, FUE wouldn't come close to those numbers without leaving it bare.  It's why the donor regions of patients who've had 6,000 grafts via FUE look far less dense than the donor regions of patients who have 6,000 grafts via FUT.  

Explain your logic. I don't follow. 

FUT takes every graft, but then the space bordering the removed strip gets stretched. And yet this stretching does not result in visible lack of density. Maybe they are making the strip small enough so that the stretching is small. (I've heard a lot of places that the stretching does not reach far. In other words only the inch below and above the strip takes the stretching.) 

Assume, you take out an inch strip. Assume the inch above and below get stretched, and now what was covered by three inches of skin is covered by two stretched inches.

So why can't you used FUE and pluck from the same three inch region? Why won't that yield the same number of grafts as strip? Why does combo FUT/FUE yield more than only FUE? 

 

Edited September 19, 2021 by olmert

[olmert]

On 2/25/2021 at 5:24 PM, Melvin- Moderator said:

That’s because it will. It’s common knowledge that using both methods yields more hair, how much is debatable, but I personally feel a minimum of 1,000 grafts extra.

Melvin says combo get you 1,000 more grafts. He says it is common knowledge. Dr. Shapiro says the same. 

They must have some reasoning why combo yields more than FUE alone. I wish they would explain. 

I want to maximize my lifetime grafts. I would rather do it with FUE alone, but I feel compelled to max out FUT before starting FUE just to be safe. It is a real pain in the ass because FUT stops me from lifting weights for 6 months. Some doctors say you can lift weights after just 10 days, but I felt the strip stretching. 

Edited September 19, 2021 by olmert

[aaron1234]

I got 7k grafts via strip before starting FUE.  There's no question that if I got around 5-6k grafts via FUE first, a strip would not be viable at that point because it would have no place to hide.  

[olmert]

28 minutes ago, aaron1234 said:

I got 7k grafts via strip before starting FUE.  There's no question that if I got around 5-6k grafts via FUE first, a strip would not be viable at that point because it would have no place to hide.  

That is doubtless true, but that begs the question why does FUT/FUE combo gives more than FUE alone. Melvin says it is conventional wisdom, but I can't figure out a viable logic. 

[Z--]

Higher Norwood checking in here. So if you begin with FUE, it sounds like as long as it isn’t over the 3k limit, it shouldn’t pose a problem to do a larger FUT later? 

One question as well. Is FUE or FUT better suited for different parts of the head (i.e. is one surgery or another better suited for the hairline vs the crown)?

[aaron1234]

23 minutes ago, olmert said:

That is doubtless true, but that begs the question why does FUT/FUE combo gives more than FUE alone. Melvin says it is conventional wisdom, but I can't figure out a viable logic. 

Because strip alone generally renders more lifetime grafts than FUE alone.  After just 1k FUE grafts I could tell that the overall density of my donor region decreased more noticeably than after the six strips. 

It's not simply the FUT/FUE combo that yields more grafts though - it's utterly maxing out on strip, then FUE that will yield the most lifetime grafts... at least with scalp hair.