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Second FUT procedure and then FUE further down the road?


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So I had my first FUT procedure at Hasson and Wong in 2016. It yielded about 4700 grafts. I'm now ready to do another HT and I'm thinking of going with the same procedure and same clinic. I know FUT is not as popular as used to be, but I feel like another FUT procedure is the logical way to go for the following reasons:

1. Obviously I still have my first scar from my first FUT surgery and so I don't think I would be loosing much ground with another FUT procedure because the first scar will ultimately be replaced by the second.

2. By going with another FUT I feel like this is the best way to maximize my overall number of lifetime grafts. I can use up the rest of my scalp laxity.

3. All other things being equal FUT:

a. Generally allows for the greatest number of grafts to be safely harvested in a single sitting

b. Overall, causes the least amount of damage in the donor area, which allows for a greater possibility of further procedures later on

c. Generally allows for higher quality grafts (transection, less traumatic than FUE)

4. Doing FUE and then FUT after can reduce overall donor density. If you go FUE then FUT, the strip taken won't have as great a donor density

5. Most likely after the second FUT procedure I won't have the laxity for anymore FUT surgeries, and then FUE would be my only option if I wanted any more procedures down the line

 

Any thoughts...quibbles...?

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I also had an FUT and thining of doing a 2nd one but is Hasson and Wong still doing FUT? I've heard and spoke with them and they now recommend and push for FUE only. Is that your experience talking with them too?

Edited by Phab
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I agree - longer term based on the research and the consensus view from the majority of HT surgeons I've seen (with one or two notable exceptions) - pursuing the maximum number of FUT procedures and then following that with FUE does maximize total lifetime doner. The number I've seen mentioned in very broad terms as rule of thumb is an incremental 2,000 grafts over an 'FUE only' patient.

On your first FUE post-FUT'ing out........you could even consider putting some grafts into the linear scar.........300 - 400 say...........AND still end up 'ahead' in terms of lifetime doner.

In your case one argument I could see for FUE would be that given your hair looks slightly fine and your focus for the next procedure might be on increasing density in the already transplanted areas.......adding this 'bulk' might be best achieved via FUE where multi-hair grafts could be cherry picked from your doner. 

An FUT strip produces what it produces in terms of 1's, 2', 3's nobody gets to decide..........FUE'ing they can hunt down the 3'/4's.......so more hair per individual recipient site incision might get you where you want to be more efficiently. if that makes sense.

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In my opinion, FUT out and then FUE

 

I do not provide medical advice, recommendations, all responses are my opinion.

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On 4/7/2021 at 7:14 PM, Dr. Suhail Khokhar said:

Would you kindly send pictures of the scar?

These are the best pictures I could do. I think my scar healed okay, about average, which is fine with me. As you can see I don't wear my hair extremely short, so I can hide it pretty well.

Donor Scar Back.jpg

Donor Scar Side.jpg

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22 hours ago, Phab said:

I also had an FUT and thining of doing a 2nd one but is Hasson and Wong still doing FUT? I've heard and spoke with them and they now recommend and push for FUE only. Is that your experience talking with them too?

Yes, and I am a little surprised. Initially, Dr. Wong recommended FUE. When I asked about FUT I had to send in a video showing my scalp laxity (which I guess makes sense to ensure one is a suitable candidate for FUT). But the rep I've been corresponding with told me that Dr. Hasson no longer offers FUT anymore. 

I live in Canada and so I also consulted with Dr. Rahal and was told the same thing, they do not offer FUT anymore. 

And I'm honestly not sure of the exact reasoning behind this. Is FUT no longer profitable from a business model perspective? It certainly is generally cheaper than FUE. If FUE, on average, is twice is much as FUT then I guess it makes sense to only focus on and promote FUE. I don't know. 

After researching for the past few weeks, I came to the consensus that clinics that offer both FUE and FUT were usually held in higher esteem because the option of FUT addresses some disadvantages of FUE (like I mentioned above), is more costly to the clinic (in the form of requiring more techs etc.), and is not as profitable as FUE. But maybe I'm wrong. I haven't delved a lot into the continual and constant advancements that FUE seems to be making. Perhaps there is a lot that I've been missing in my research?

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From my general research and specifically from the Shapiro study @Melvin-Moderator posted in this thread, it seems as if more and more agree that with advancement in instrumentation over the past 6 years, FUE and FUT are equally as effective in terms of graft survival and transection and can yield the same amount of lifetime grafts, however, the Shapiro study posit that if you combine the 2 techniques over a lifetime of a patient, you can yield more grafts. The Shapiro study says as much as 3k grafts.

As for FUE being pushed, it seems to be that you need less staff rather than an entire team of techs= more training, etc.

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