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BHR Clinic - FUE or FUT


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One question that we frequently receive at the clinic and often read on the forum, is which technique is best, or which technique is more appropriate for a particular patient - FUE or FUT?

In this video, we'll review the FUE (Follicular Unit Extraction) and FUT (Follicular Unit Transplantation) techniques and discuss how Dr. Bisanga at BHR Clinic conducts both hair transplantation techniques and based on a thorough assessment and the personal characteristics and objectives of each patient, will decide which technique may be the most appropriate.

 

Edited by Raphael84
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Patient Advisor for Dr. Bisanga - BHR Clinic 

ian@bhrclinic.com   -    BHR YouTube Channel - https://www.youtube.com/channel/UCcH4PY1OxoYFwSDKzAkZRww

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

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Great video thanks for sharing @Raphael84 I foresee Dr. Bisanga's channel blowing up in the future. 

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I’m a paid admin for Hair Transplant Network. I do not receive any compensation from any clinic. My comments are not medical advice.

Check out my final hair transplant and topical dutasteride journey

View my thread

Topical dutasteride journey 

Melvin- Managing Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media: Facebook, Instagram, Linkedin, and YouTube.

 

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Hi @Raphael84- I appreciate you posting this very informative video about FUE and FUT. I am many others on this forum are trying to uncover some truth around how to best maximize lifetime donor grafts.

In my research on this very topic, below I have documented views found through research and/or consulting with several well known and regarded FUE only surgeons, many who have left performing FUT (claiming that it wasn't entirely market driven).

As you look at the arguments given by these FUE only surgeons below, do you think there is any validity to any of them which would in actuality lead to their being less of a difference in lifetime grafts being able to harvest in FUE alone (over several procedures) vs combining both techniques over several procedures.

 

Thank you!

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

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12 hours ago, SLA said:

Hi @Raphael84- I appreciate you posting this very informative video about FUE and FUT. I am many others on this forum are trying to uncover some truth around how to best maximize lifetime donor grafts.

In my research on this very topic, below I have documented views found through research and/or consulting with several well known and regarded FUE only surgeons, many who have left performing FUT (claiming that it wasn't entirely market driven).

As you look at the arguments given by these FUE only surgeons below, do you think there is any validity to any of them which would in actuality lead to their being less of a difference in lifetime grafts being able to harvest in FUE alone (over several procedures) vs combining both techniques over several procedures.

 

Thank you!

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

I think it is also important to note that what matters, is how much hair we are left with as we continue to progress in hair loss. When moving a large amount of FUE, you are inevitably extracting from a larger area and consequently an area that is not as DHT resistant. When you start with FUT, you minimize this greatly which allows you to utilize that 'sweet spot' of DHT resistant hair. Then you can move over to FUE as the adjunct procedure.

The other factors you mention about the skin stretching and the change in direction are interesting and i look forward to Dr Bisanga answering them.

Doctors like Dr Konior and Dr Wong say that combining both maximizes lifetime graft potential. It would be great if they could answer your list of questions as well. 

Edited by kramer79
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On 4/16/2021 at 9:55 PM, kramer79 said:

I think it is also important to note that what matters, is how much hair we are left with as we continue to progress in hair loss. When moving a large amount of FUE, you are inevitably extracting from a larger area and consequently an area that is not as DHT resistant. When you start with FUT, you minimize this greatly which allows you to utilize that 'sweet spot' of DHT resistant hair. Then you can move over to FUE as the adjunct procedure.

The other factors you mention about the skin stretching and the change in direction are interesting and i look forward to Dr Bisanga answering them.

Doctors like Dr Konior and Dr Wong say that combining both maximizes lifetime graft potential. It would be great if they could answer your list of questions as well. 

Yes, I would love for others like Drs. Wong and Konior to give their opinion on if there is any truth to the FUE surgeon arguments detailed in this list.

@Melvin-Moderator, could this be a possibility?

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3 hours ago, SLA said:

Yes, I would love for others like Drs. Wong and Konior to give their opinion on if there is any truth to the FUE surgeon arguments detailed in this list.

@Melvin-Moderator, could this be a possibility?

Dr. Konior did touch on this briefly in my interview with him and Dr. Nadimi. It really comes down to the individual. I will be speaking with Dr. Wong as well. Stay tuned.

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I’m a paid admin for Hair Transplant Network. I do not receive any compensation from any clinic. My comments are not medical advice.

Check out my final hair transplant and topical dutasteride journey

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Topical dutasteride journey 

Melvin- Managing Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media: Facebook, Instagram, Linkedin, and YouTube.

 

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Thanks @Melvin-Moderator- I appreciate your conversation with Dr. Konior and Dr. Nadimi (which I saw). Very informative.

I think what @kramer79(correct me if I am wrong) and I are after is not so much about whether FUT or FUE is better as there seems to be some consensus from your interviews that they could be performed equally as well (some might be better suited for one over the other), but in regards to the lifetime graft assertions from well respected FUE surgeons (which I laid out above) that claim you can get at least as much hair from FUE alone over the course of a patient's lifetime rather than a combination of FUT and FUE.

The vision would be to present each point and get the doctor's take on whether their is truth, partial truth or it is beeswax :).

So here is be a mock conversation:

Me: "I have heard from a couple of respected FUE surgeons that 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. Is that true? If so, how common is this occurrence?"

Dr.: "Actually, this could happen, but is very rare and usually only happens if you attempt a 3rd strip."

Something along these lines :).

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@SLA Thanks for your questions.
They present a great opportunity to continue the discussion with a little more depth and specifically addressing the points that you have asked.
It is important to remember that this is in relation to quality surgery with a skilled surgeon, and in our case at BHR Clinic, again Dr. Bisanga has no bias toward either technique.
 

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.

FUT in essence takes from surface area, so if for arguments sake, if 60cm2 is excised and therefore every graft is utilised from it, then you have the donor area minus the strip surface area to then harvest from in FUE. The doctor would likely be conscious of the area directly above a strip scar when performing FUE to retain density to hide the scar, but this is negligible and not at all comparable in regards to utilising all grafts within the strip (please see below image)

There are several cases on the forum whereby we did both in synergy to get the graft numbers needed. We were still then able to extract a significant graft count via FUE to then bolster the numbers without over harvesting as the example below.

6161 Grafts - FUT and FUE combination surgery

 

1360182289_Screenshot2021-04-19at20_15_50.thumb.png.55b214442e5d49a770d496bd1d989605.png

 

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

As the above case shows utilising both FUT and FUE, this does not present any issue for Dr. Bisanga.
The angles of hair will change somewhat as the doctor extracts throughout different areas of the donor in all patients, including those without prior FUT surgery. This is the natural angulation and direction of our native hair and this should not cause a problem for a quality surgeon.

FUE and FUT are only as good as the surgeons performing them. The closure of the strip is also key in how the hair direction will change and some patients may be conscious of a change in hair angles due to the size of the strip that may have been taken, but again this shouldn't have any real effect on subsequent FUE surgery and the cases presented in the original video do not have this as a significant issue.

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. 
When closing the strip, you are pulling and closing the scalp with less surface area, so naturally there will be a stretching effect from the closure. The idea that any displacement would negate the positives of strip surgery in terms of graft count is not accurate.

In the example cases linked below, the patients did not need to come back for an equivalent graft count due to the closure then “spacing out” his native hair. Although there is a displacement it is not like for like. When looking at these larger strip cases, even with the crown in tact, you can still see the natural crown "swirl" has not been pulled/displaced out of position. 
This can also be seen in several other examples where the crown has been lost and the initial strip provides grafts to restore the frontal third/half for example. The crown is not displaced so dramatically. If you look a the final of these 3 example cases, you can clearly see the position of the crown pre surgery, and there has been no displacement when comparing to the post surgery images at 10 months.

 

You will actually see my personal post to the above case sent in 2013 long before any association with BHR Clinic.

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

FUT is "blind" where the doctor is cutting the strip and Dr. Bisanga with both experience of reading direction and using magnification will cut the strip out. Most of the grafts, 90 percent, are not in the border/periphery of the strip but more integral so the VAST majority are "non-blind" to then sliver and dissect meaning no transection. There is a danger of transecting across one plane when harvesting the strip but in comparison to FUE then ALL of the grafts are in essence "blind" as all of them are punched individually and therefore could potentially be transected in any surrounding area as you encapsulate the whole follicular unit. This is where the doctor's skill comes in to play.  Dr. Bisanga in FUE and particularly for hair line work will target the harder areas for finer hairs that are more acute to the skin, whereas many FUE clinics will only harvest from the richer and easier occipital area and there are many examples of this on this forum also. So, the reading/understanding of direction is important in both techniques but if the doctor (or tech), if not a doctor punching clinic, does not accurately read the hair direction, this would mean that FUE is more prone to issues where 100 percent is "blind".

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.  

For both techniques it is important to have sufficient magnification to see also the finer hairs and especially so for hair line work to not place a double that has one hair resting, into a hair line that requires a single. 

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. 

As said prior, transection in FUT is not a massive issue relative or comparable to FUE in that most of the units are dissected with full vision. When an FUE follicle is transected, part remains in the scalp but this does not guarantee it will grow back. It may grow back, but it really depends what is transected and in the event that it were to grow back, the structure and/or diameter of the follicle would likely be compromised. In all honesty, you would be looking to select a doctor with a low and consistent transection rate as opposed to them falling back on the "safety net" that is, part of the follicle will remain and not be lost.

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. 

This is not unique to Strip. Grafts when extracted via FUE of 2,3,4 can also be further dissected and this is often the case for clinics who utilise the rear area of the donor to harvest follicles for the hair line that requires singles. This is also an insincere method of attaining more GRAFTS, as this is not accurate when speaking of complete follicular units. Of course there are legitimate examples of when this may be necessary to provide further single hairs when the donor is not able to provide sufficient numbers due to the patient’s particular circumstances.

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. 

As said the skill of the surgeon really is paramount more so than the technique and FUE in poor hands will cause problems to the donor and over a larger area, so the different issues are not inherent to one technique as such, but more so the quality of the work can be a variable. We have examples of having performed large strips and then the patient has returned for a second strip and FUE and the patient has obtained graft numbers without significant issues of the above mentioned. That said, strip can cause some whispy hair under the scar or wider down also but at times the surgeons approach and ability does influence this and in terms of total graft availability, such an effect is not comparable to the "extra" grafts than could be harvested using combination approach.

As you can see in the below case, this patient´s first surgery was FUT, followed by a subsequent combination surgery of FUE + FUE with FUE grafts punched from below his strip scar.

545467200_Screenshot2021-04-19at20_42_40.png.84e7a75e570670deb6c87cbbfdc0edb8.png1635138448_Screenshot2021-04-19at20_42_47.png.3bfdfa23273dcc69b1239718d2111390.png109580760_Screenshot2021-04-19at20_42_53.png.68c8135831f3321bd1616ac5522bb030.png1573983169_Screenshot2021-04-19at20_43_17.png.14e8b344e1a9cc9576b5aedd529a21bf.png1286734295_Screenshot2021-04-19at20_46_06.thumb.png.58dbaba11a6f13c786f3cf8f3017c8eb.png787040101_Screenshot2021-04-19at20_43_25.png.4546601cf3e586ab108ee7eb3a79eef6.png803170939_Screenshot2021-04-19at20_45_09.thumb.png.a9feb596bed011d05301cb2921d0bb6a.png

 

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

Working under magnification will show the finer hairs and the skill and handling of the doctor and technicians performing the task is paramount.

Edited by Raphael84
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Patient Advisor for Dr. Bisanga - BHR Clinic 

ian@bhrclinic.com   -    BHR YouTube Channel - https://www.youtube.com/channel/UCcH4PY1OxoYFwSDKzAkZRww

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

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1 hour ago, Raphael84 said:

@SLA Thanks for your questions.
They present a great opportunity to continue the discussion with a little more depth and specifically addressing the points that you have asked.
It is important to remember that this is in relation to quality surgery with a skilled surgeon, and in our case at BHR Clinic, again Dr. Bisanga has no bias toward either technique.
 

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.

FUT in essence takes from surface area, so if for arguments sake, if 60cm2 is excised and therefore every graft is utilised from it, then you have the donor area minus the strip surface area to then harvest from in FUE. The doctor would likely be conscious of the area directly above a strip scar when performing FUE to retain density to hide the scar, but this is negligible and not at all comparable in regards to utilising all grafts within the strip (please see below image)

There are several cases on the forum whereby we did both in synergy to get the graft numbers needed. We were still then able to extract a significant graft count via FUE to then bolster the numbers without over harvesting as the example below.

6161 Grafts - FUT and FUE combination surgery

 

1360182289_Screenshot2021-04-19at20_15_50.thumb.png.55b214442e5d49a770d496bd1d989605.png

 

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

As the above case shows utilising both FUT and FUE, this does not present any issue for Dr. Bisanga.
The angles of hair will change somewhat as the doctor extracts throughout different areas of the donor in all patients, including those without prior FUT surgery. This is the natural angulation and direction of our native hair and this should not cause a problem for a quality surgeon.

FUE and FUT are only as good as the surgeons performing them. The closure of the strip is also key in how the hair direction will change and some patients may be conscious of a change in hair angles due to the size of the strip that may have been taken, but again this shouldn't have any real effect on subsequent FUE surgery and the cases presented in the original video do not have this as a significant issue.

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. 
When closing the strip, you are pulling and closing the scalp with less surface area, so naturally there will be a stretching effect from the closure. The idea that any displacement would negate the positives of strip surgery in terms of graft count is not accurate.

In the example cases linked below, the patients did not need to come back for an equivalent graft count due to the closure then “spacing out” his native hair. Although there is a displacement it is not like for like. When looking at these larger strip cases, even with the crown in tact, you can still see the natural crown "swirl" has not been pulled/displaced out of position. 
This can also be seen in several other examples where the crown has been lost and the initial strip provides grafts to restore the frontal third/half for example. The crown is not displaced so dramatically. If you look a the final of these 3 example cases, you can clearly see the position of the crown pre surgery, and there has been no displacement when comparing to the post surgery images at 10 months.

 

You will actually see my personal post to the above case sent in 2013 long before any association with BHR Clinic.

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

FUT is "blind" where the doctor is cutting the strip and Dr. Bisanga with both experience of reading direction and using magnification will cut the strip out. Most of the grafts, 90 percent, are not in the border/periphery of the strip but more integral so the VAST majority are "non-blind" to then sliver and dissect meaning no transection. There is a danger of transecting across one plane when harvesting the strip but in comparison to FUE then ALL of the grafts are in essence "blind" as all of them are punched individually and therefore could potentially be transected in any surrounding area as you encapsulate the whole follicular unit. This is where the doctor's skill comes in to play.  Dr. Bisanga in FUE and particularly for hair line work will target the harder areas for finer hairs that are more acute to the skin, whereas many FUE clinics will only harvest from the richer and easier occipital area and there are many examples of this on this forum also. So, the reading/understanding of direction is important in both techniques but if the doctor (or tech), if not a doctor punching clinic, does not accurately read the hair direction, this would mean that FUE is more prone to issues where 100 percent is "blind".

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.  

For both techniques it is important to have sufficient magnification to see also the finer hairs and especially so for hair line work to not place a double that has one hair resting, into a hair line that requires a single. 

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. 

As said prior, transection in FUT is not a massive issue relative or comparable to FUE in that most of the units are dissected with full vision. When an FUE follicle is transected, part remains in the scalp but this does not guarantee it will grow back. It may grow back, but it really depends what is transected and in the event that it were to grow back, the structure and/or diameter of the follicle would likely be compromised. In all honesty, you would be looking to select a doctor with a low and consistent transection rate as opposed to them falling back on the "safety net" that is, part of the follicle will remain and not be lost.

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. 

This is not unique to Strip. Grafts when extracted via FUE of 2,3,4 can also be further dissected and this is often the case for clinics who utilise the rear area of the donor to harvest follicles for the hair line that requires singles. This is also an insincere method of attaining more GRAFTS, as this is not accurate when speaking of complete follicular units. Of course there are legitimate examples of when this may be necessary to provide further single hairs when the donor is not able to provide sufficient numbers due to the patient’s particular circumstances.

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. 

As said the skill of the surgeon really is paramount more so than the technique and FUE in poor hands will cause problems to the donor and over a larger area, so the different issues are not inherent to one technique as such, but more so the quality of the work can be a variable. We have examples of having performed large strips and then the patient has returned for a second strip and FUE and the patient has obtained graft numbers without significant issues of the above mentioned. That said, strip can cause some whispy hair under the scar or wider down also but at times the surgeons approach and ability does influence this and in terms of total graft availability, such an effect is not comparable to the "extra" grafts than could be harvested using combination approach.

As you can see in the below case, this patient´s first surgery was FUT, followed by a subsequent combination surgery of FUE + FUE with FUE grafts punched from below his strip scar.

545467200_Screenshot2021-04-19at20_42_40.png.84e7a75e570670deb6c87cbbfdc0edb8.png1635138448_Screenshot2021-04-19at20_42_47.png.3bfdfa23273dcc69b1239718d2111390.png109580760_Screenshot2021-04-19at20_42_53.png.68c8135831f3321bd1616ac5522bb030.png1573983169_Screenshot2021-04-19at20_43_17.png.14e8b344e1a9cc9576b5aedd529a21bf.png1286734295_Screenshot2021-04-19at20_46_06.thumb.png.58dbaba11a6f13c786f3cf8f3017c8eb.png787040101_Screenshot2021-04-19at20_43_25.png.4546601cf3e586ab108ee7eb3a79eef6.png803170939_Screenshot2021-04-19at20_45_09.thumb.png.a9feb596bed011d05301cb2921d0bb6a.png

 

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

Working under magnification will show the finer hairs and the skill and handling of the doctor and technicians performing the task is paramount.

Wow I should pin this post. What a great detailed reply Raph 👏🏼

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I’m a paid admin for Hair Transplant Network. I do not receive any compensation from any clinic. My comments are not medical advice.

Check out my final hair transplant and topical dutasteride journey

View my thread

Topical dutasteride journey 

Melvin- Managing Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media: Facebook, Instagram, Linkedin, and YouTube.

 

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Going over the points from @SLA points and @Raphael84 reply. I come to come the conclusion that an fue procedure should be done before an fut. Also I think it can’t be overlooked for someone that’s getting a HT, it’s scary to think about having a failed surgery then having a scar then still being bald. I think getting a fue first at least will give you confidence if you decide to go fut on later.

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15 minutes ago, Domino said:

Going over the points from @SLA points and @Raphael84 reply. I come to come the conclusion that an fue procedure should be done before an fut. Also I think it can’t be overlooked for someone that’s getting a HT, it’s scary to think about having a failed surgery then having a scar then still being bald. I think getting a fue first at least will give you confidence if you decide to go fut on later.

Interesting point @Domino.

I assume that it is probably a case by case basis depending on donor, but if one were to have an average donor, if one were to start with FUE what is the maximum amount of grafts that could be harvested before FUT no longer becomes an option in that you couldn't conceal a strip scar.

Any ideas @Raphael84? I heard Ron Shapiro in the interview Melvin had with the Shapiro Group say not to go over 4k grafts with FUE if one wanted to do FUT in the future. 

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@qui bono @SLA Im speaking with myself in mind, I don’t mean to speak in general. I plan on having fue as my first surgery. As of right now I’m rather bald and keep my hair short. So if I was to start wear my hair longer fut could be a possible choice for a second surgery even though the strip won’t as fruitful, it still could be beneficial. 

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Great further discussion and conversation.

As explained in the original video and as alluded to by @qui bono, avoiding the strip area and extracting FUE around this can be an option providing the graft demands are more modest.

Based on @SLA and @Domino comments, Dr. Bisanga added the following response -

"What is very important to appreciate is that donor evaluation is key before undergoing any type of surgery (FUE or FUT).
I remember back in 2005, I was one of the few advocates of FUE surgery and so have been consistently performing both techniques for many years.

If a patient may have less than average donor density, then perhaps FUE should not be the first option because the donor area would present lower density post surgery making any potential FUT surgery more complicated due to the fact that it may be difficult to hide a strip scar with less than optimal density.

I do not personally believe in "mega-session" FUE  (4000+ grafts) on patients who have an average donor area because to extract such a high graft count tends to decrease the patient´s overall density (%) and the aggressive extraction can present post FUE miniaturisation (overwhelming the donor area and its ability to optimally heal) leaving the remaining hair quality sub-optimal. In such cases, the better approach would be to plan 2 smaller sessions of 2500 grafts rather than aggressively push a 5000 graft session of FUE.

Some doctors/clinics who only offer FUE surgery may not have the expertise to understand donor depletion and the consequences this can present should a patient progress to NW5-6 and therefore need more grafts for the future, so it is easier to negate FUT than to really appreciate and understand the limits of both techniques and our priority should always be the long term, not only considering tomorrow."

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Patient Advisor for Dr. Bisanga - BHR Clinic 

ian@bhrclinic.com   -    BHR YouTube Channel - https://www.youtube.com/channel/UCcH4PY1OxoYFwSDKzAkZRww

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

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Once again, @Raphael84, thank you and Dr. Bisanga for the thorough responses and walking through your reasoning on this topic with so many differing opinions. It is so challenging to decipher between marketing and truth. 

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