Does getting FUE done first decrease total yield?

[TC17]

I apologize if this question has been answered before, but I did not see an answer anywhere.

 

If you undergo a FUE procedure before strip, is your total availability of grafts decreased? For example, if I have 6,000 grafts available via strip, and I undergo a 2,000 graft FUE surgery, would I still have the 4,000 left (via strip or FUE) if necessary?

[hdude46]

think about what u are asking here....fue allows you to get graphs that strip simply cannot. fue allows for a higher number of graphs b/c it can take fu's from the safe zone and it doesnt have to be a in a straight line. just be careful tho, as it seems from your posts u have lots of 6 and 7's in your family history.

[thanatopsis_awry]

From all I've been told the best way to maximize overall harvesting of your donor is to "strip out" and then go to FUE.

[the B spot]

No, not really---it will decrease the number of grafts available via strip in the future, but if your responsibly taking from the entire donor area--you should only be about 20-25% less when you remove the strip.

 

For example, you remove 20% via FUE which ends up being 3500-4000 grafts for you.

 

Then you take a strip 20cm X 1.25cm wide which normally at average density would yield 2125 grafts. However, you have reduced your overall donor density by 20% which should reduce your strip 425 grafts

 

2125 - 425 = 1700 grafts.

 

Obviously this is an average donor density patient, taking only 20% from the entire donor, and not overharvesting any one point on the donor.

 

Another point is that regardless of laxity you would need to be extra careful to make sure a thin scar is produced as you will have less hair to cover the scar b/c you removed some via FUE.

 

I hope you get the idea of how doing FUE will impact your future strip grafts.

 

My opinion is if your going to max out, strip followed by FUE is your best bet.

 

If your against strip, then do FUE.

 

I think if you do FUE, you should stick with FUE until you cannot take any more from the donor--otherwise the reasoning for doing FUE 1st is severely retarded.

 

Hope this is what your looking for TC!

Take Care,

Jason

[TC17]

That is what I have heard too thana, but I don't want to undergo a strip surgery. While there aren't any full blown 7's in my family, my dad and maternal uncle are both NW 6.5's.

 

I'm only 26 years old, and am cautiously optimistic that within the next 10 years we will have better tools to fight baldness. I would hate to undergo a strip procedure now, and live the rest of my (hopefully long) life with a 30cm long scar if it proves to be unnecessary in the very near future. After all, hair cloning or a baldness cure would render strip surgery an antiquated method very quickly. I look at FUE as buying me the time necessary for hair cloning to be viable, or for a cure to arrive.

 

Now, if neither of those occur, I would still benefit by retaining the option to cut my hair very short without a strip scar showing. I do realize that FUE is not scarless, however, all will concede that the appearance of the scar is less conspicuous than in strip surgery 99/100.

I have no idea if in 10 or 15 years if I would want to keep up with my hair loss. I might decide that I would prefer to just buzz it short and be done with it. FUE should be able to afford me that option.

 

Most important for me is the fact that I have no idea where my hair loss pattern is going. As I said above, my dad is a NW 6.5, his brother is a NW 2, paternal grandpa is 89 years old and a NW 2, maternal grandpa was a NW 3 when he died at age 75, and my mom's four brothers are NW 6, NW 6.5, NW 2, and NW 5. If I bald to the level of my dad, it is likely that I will not have nearly enough donor to cover more than the first 2/3rds of the scalp, and even then it may only be a light dusting. For me personally, I think that men look better when they are noticeably bald when they keep their hair very short.

 

One final point. This may be wrong, but it seems to me as though when hair is cut very short that it appears to be thicker. Bill is a great example of this. When he shaved down for his recent surgery his hair looked great in my opinion. It looked like he had much better coverage than he did when it was long. If I progress to a high NW level (which is likely), I might better be able to utilize my limited grafts if I keep my hair very short.

[P.J]

TC17,

 

Its a well thought out idea - but it would be money well spent if you avoid FUE at your age.

 

FUE is costly and the survival percentage from what I have seen and read is considerable less than strip.

 

The amount of hair you need to make a difference makes FUE a waste of money unless dont have a typical MPB with little loss expected in the future

 

Just my 2 cents

 

PJ

[TC17]

I have to disagree with you P.J., as I am pretty sure that the survival rate of FUE is essentially equal to that of strip when performed properly. I also believe that total yield from exclusive FUE is less than that of strip.

 

However, if hair cloning or a cure never become available, and I find myself at 40 years old with no more grafts available via FUE, I can then decide to continue with transplantation via strip, or buzz down. According to B Spot, you do not decrease the overall number of grafts available if you undergo FUE first. Consequently, undergoing FUE first (while hoping for better remedies for baldness and avoiding a long strip scar) seems to make more sense to me because I can always get strip performed in the future if no improvements are breakthroughs are discovered. Flexibility and choice in the face of an uncertain future are the biggest virtues of FUE in my opinion.

 

All of my conclusions have been built upon the premise that final graft count will not be compromised if I undergo FUE first. If that is a faulty premise, then everything I have said after that is wrong as well. If I'm wrong PLEASE someone correct me.

[the B spot]

There are always trade off's when choosing one type of surgery over another.

 

Strip has stood the test of time and will continue to do so. However, it comes with a scar that will be there forever. For most this is no problem and in the hands of a proper clinic, generally results in an acceptable scar easily hidden.

 

FUE is gaining momentum and is now being examined and performed by some caring and ethical doctors who will not over-sell the procedure.

 

If I had to say for most people the yield for FUE will be less than the yield for strip. Even at 3-4% loss via FUE, over the course of thousands of extractions that is still a decent amount of grafts. Most consider this an acceptable tradeoff.

 

We have tried to combat this by taking the slower, more controlled approach--over 2-3 days if necessary.

 

Quite honestly, I think the survival rate of FUE grafts ONCE EXTRACTED is on par with strip grafts---but again, if you ask me logically "If I individually punch out 3-4K of grafts vs taking 4000 grafts via strip, which will yield higher?

 

The answer is strip--but I think doctors like Feller, Bisanga, Harris, Mwamba to name a few have shown excellent yield, using proper tools and by keeping sessions reasonable.

 

The question TC asked was how will doing FUE impact future strip sessions, not which overall yield would be higher.

 

Again, if your using 1mm or less punches and your responsibly managing the donor region (20-25% extraction max) then your just decreasing the overall follicular units in the entire donor region--including the region where you would take the strip.

 

(Ie--if your donor density is 85 fu/cm2 and you take 20% or 17 follicular units per cm, then your overall donor density will decrease to 68 fu cm/2)

 

Hope this helps/clarifies,

Jason

[HairHope]

Go FUE, You can send me flowers later.

 

Signed,

An experienced patient.

[TC17]

B Spot,

 

Assuming you lose 4% of your grafts via FUE, each 4,000 grafts harvested you would still get around 3,850 viable grafts. Do you feel that that seemingly minimal loss is worth choosing strip over FUE? Can such a small number of grafts really make any cosmetic difference?

 

Last, why is the donor area only harvested up to 30%? If we can lose 50% of our hair in a given area without noticing, why are doctors reluctant to go 35%, 40%, 45%? I measured the donor area of my dad (a NW 6.5), and in my best estimate his safe zone measures 6.35cm x 29cm for a total area of 184.15cm2. Assuming he has average density of 80 fu's per cm2, and you take only 35 fu's per cm2, you come out with around 6,500 grafts. That would still leave him with about 44% of his donor area intact. I'm sorry for all of the questions, but I really do not want to commit to strip, but I know that I will one day be at least a NW 6 and the 3,000 to 4,000 grafts available using current FUE techniques will surely not be enough to reach my goals.

[Bill - Seemiller]

There have been some excellent answers and thoughts provided on this thread.

 

Personally, if you're going for maximum hair growth yield, I think it's better to max out via follicular unit transplantation (FUT) via strip surgery followed by follicular unit extraction (FUE) if necessary. However, there are varying arguments on this.

 

Those who advocate strip first then FUE argue the following:

 

1. Consistency with FUT strip is usually higher

2. FUE can damage the surrounding tissue and make surrounding follicles less viable for transplanting during a strip procedure. This could potentially impact hair growth yield

3. Follicular unit transplantation via strip is more cost effective

4. Because the amount of hair that can be moved with strip surgery usually exceeds FUE, those with higher degrees of hair loss can often meet their hair restoration goals with strip alone. Those who start with follicular unit extraction almost inevitably require a strip procedure to meet their goals.

 

Those who advocate FUE first then strip would argue the following:

 

1. FUE can be just as consistent as FUT strip under the right circumstances (debated)

2. Doing FUT first may alter the direction of the surrounding hair follicles and make them more difficult to extract via FUE, increasing the risk of lower yield

3. FUE costs are relatively low at some clinics

 

Ultimately, those who want to avoid a linear scar like the plague should consider FUE. However, understand that FUE is not 'scar free' and produces a different kind of scarring. Also, consider caring and ethical hair transplant surgeons who are realistic about what can be achieved with FUE rather than those who overhype its benefits while downplaying its limitations and risks.

 

I hope this helps.

 

Bill

[the B spot]

The 3-4% is what I personally feel the average loss should be during the extraction process, some patients will have less, some may have more...either way for those not wanting a strip scar, it is an acceptable trade off.

 

Another point is that not all transected grafts are lost, some regrow in the donor and if you transect a 3 hair graft, but still get a 1 hair out of it, it still counts as a transection, even though you have a 1 hair graft left.

 

TC I guess the question of donor extraction is left to each clinic. Most clinics feel the 20-25% mark is about the maximum you want to take from the donor for most patients. Some patients will be less, others who are blessed with thicker donor could possibly be more.

It is about being responsible and doing a session, assessing the impact on the donor and then planning out future sessions.

 

Quite frankly you nor your doctor know how a large FUE session will leave your donor looking, which is why using smaller tools, not overharvesting from any particular spot on the donor is paramount to achieve the full efficacy of FUE--- At some point, even if the scarring is non-existent, gaps in the donor will serve to give the donor a moth-eaten look, which essentially will serve to look like scars, imo.

 

To answer your question, there is nothing wrong with harvesting more than 20-25%---but harvesting 30-35-40% at one time might create the scenario I detailed above. We are keeping sessions to around 2000--maybe the right patient 2500 max, over 3 days just to make sure we properly space out the extractions, handle the grafts carefully, etc... once the patients grow, in we can reassess the impact and go forward.

 

I do not profess to speak for all FUE clinics, but if you look at the work of Dr. Feller, Dr. Harris, and Dr. Bisanga (to name a few) they generally do 1000-2500 grafts max in one session--and they all have great results. You never hear of them over-harvesting a patient either. They do a great job, then go back, assess the impact on the donor, then plan accordingly.

 

There seems to be a balance or tipping point when doing FUE---it has to be true---you can take 5 patients with the same level of loss and come up with 5 different results on the donor--some you can continue to take and take from, whereas others one session of 2000-2500 grafts might be it. It is the same with strip--one guy has 10K of strip grafts, one guy has 4000, and the other 3 have 6-8K.

 

 

My last point to you TC is that even if you go to a NW 6, even if you take all your available grafts, it may not mean you will have a dense head of hair---many of us have to choose higher frontal density and trade a bald crown or light coverage in the crown---it may be that taking 3-4K of grafts, giving you a great hairline, coverage over the frontal 100-120cm and still leaving you the ability to buzz down to a #2 on the sides with a military cut or shorter haircut on top looks great or will give you the same satisfaction that doing 8500 grafts will give you via strip.

 

Sorry for the long post,

Jason

[the B spot]

We posted at the same time Bill--those are excellent points.

[P.J]

TC,

 

I believe with FUE there is more damage happening that first meet the eye.

 

First try taking a sharp knife and try hitting dots on a paper 1000 times in row - how many direct hits will you get. If you get 3-5% you are better than most even in ideal conditions.

 

Now take that dot which on top appears straight and underneath can go off in different directions

and how many times do you cut part of the root underneath?

 

So there is collateral damage to surrounding grafts because no one is going to hit that dot 1000 out of 1000 times every day and damage to existing grafts underneath because some off the roots grow off in a odd directions

 

The hair count is also reduced like B-spot said they can cut into a 3 hair graft and leave one standing but actually have many three haired grafts can you pull safely with these small instruments. And how many of those three haired grafts are turned into two haired and the last hair dies off

 

No with all that said I believe FUE is okay if you never plan on getting a strip and you have very minimal hairloss with very little chance for major hairloss in the future

 

 

PJ

[Dazed]

This kind of thread is why I come to this site. Several of my questions have been answered right here. I now know I will go with the strip. I have been looking into Dr Ron Shapiro, and I here many good thigs about him here.

[TC17]

P.J.,

 

I think I get your point, but I'm not quite sure your analogy is accurate. A knife is far more crude than the 7mm-9mm extraction point used by the top clinics, and the traditional problems associated with extraction have been minimized as a result of refinements to FUE. I do understand your point though, and they are legitimate limitations with current FUE, but I am hopeful that with better tools comes better yields, and the eventual demise of strip.

 

Dr. Feller wrote a very interesting and infromative article regarding stripping out and then going FUE to maximize graft count. I'll link to it at the end. I'm not crazy, and I do not want anyone to think that I'm advocating FUE over strip in all circumstances. Rather, as I stated above, I think FUE is better for younger patients, even those that anticipate extensive balding down the road, because of the flexibility associated with not having a strip scar. I don't think FUE is the future, but I do believe that it is closer to the future than strip surgery. I hope that we're at the tail end of the strip experience, and that within the next decade we've evolved the process so that harvesting 7,000 grafts by FUE is rather mundane. Don't forget, even 5 years ago it was uncommon for even the top physicians to perform 2,500 grafts from strip on a consistent basis, and now look where we are. Just because there are current limitations and roadblocks does not mean that there were always be. I just cannot fathom why anyone with a virgin scalp and an uncertain balding pattern would ever undergo strip.

 

* this is the article written by Dr. Feller. Note his last sentence where he says that if he were to undergo a procedure he would go strip, but in ten years, who knows. I admire Dr. Feller's openness to discuss the limitations with FUE, but that last comment I take to be in line with my personal beliefs. If I have misinterpreted that, please feel free to correct me.

http://www.regrowhair.com/hair...-fue-misconceptions/

[P.J]

TC,

 

Yes, the tools for the analogy were off but the strain on the Drs hands and eyes are not and I still believe the miss rate or hit but cut off a hair or two is more like 10%+

 

I am still not taking into account the graft damage when actually removing the graft that Dr Feller discusses - the twisting. pulling and skinny graft effect - which also in turn lowers the success rate.

 

I am just trying to help you from my experiences

 

I had the same idea as you at one time but the amount of time it takes to get results and usually the FUE session are small - you end up wasting a year of your life for minimal improvement not counting the pain and discomfort of sitting in the chair face down for hours on end - then you go through it again and waste another year.

 

Buddy, good luck in what ever you do - I wish you all the best

 

PJ

[MrJobi]

All things consistent. to the average N4 or above I would go Strip first and then use FUE to refine the area when you feel large scale donor harvest is enough. To me it is like using a broad paint brush vs a fine one. I am not saying in anyway there are other solutions, however this seems to make the most sense in my mind based on time,cost,& hair resources

 

After 3 strips i may in the future do some minor filling in via FUE ( 1000 or so)

[Take a chance]

So from what I understand it is better to max out your donor via strip before FUE.

 

If you are an NW6 and have maxed out your donor area by the time you're in your 30's or 40's then you continue to lose native hair especially from the sides and crown (NW6.5) can FUE help to fill in the bald areas? The last thing you would want is an island of hair followed my bald areas on the side or an expanding crown that looks unnatural.

[HTHELP]

TC17- I'm in the same boat and my HT plan (if it ever happens) is exactly the same. My concern of progressing to NW6-7 (which I think more people should be concerned with) is the driving force. At the end I think that having the buzzed look at a #1 (or maybe worse case #2) is a HELL of a lot better then being married to one hairstyle (some kind of combover). When doctors like Dr.Beehmer post his NW7 results consitently (I think he does great work and I happen to think he underated/underapprecciated overall) but in most of those cases the front to back hairstyle is all they can pull off. Personally I don't care for that (I don't think I would when i'm older either as i'm currenlty 31). I honestly think for younger guys who have are experiencing advanced balding (I'm in the NW4-5 category as a diffuse thinner) that the FUE option (framing the face with the ability to buzz down now or later) is the best solution. I know some people always say "why waste the money and just shave down" but I think there is a big difference in the slick bald look and the stubble look (the latter being the MUCH better look/option). I'd love to hear from some of the docs (SMG, Feller etc) that have performed FUE for someone who was looking to achieve this who was already at an NW4/5 or worse level. On a previous post that someone started they asked what kind of density needed to be achieved in order to pull of the buzzed look with the illusiong of decent density (and if it would be less then having your hair grown out) I don' t think any doc's (or any of the valued members here responded to that). I would think the density would be much lower as I know when my hair is shorter it masks my thinning.

 

Bill- do you know what density you were at prior to your 3rd surgery? Your shaved head pic stands out to me.

 

Thana- I thought your buzzed cut (even though you complained about butchering it!) looked good as well, but I think your density was fairly high...

 

Anyhow I think this is the "safest" way to go for someone who wants to pull of some hairstyles now and leaves them the most forgiving options later on. (I realize the pitfalls/risks of yield), at the same time I think in the hands of a competent doctor (SMG/Feller etc) that the chances of a good results are good.

[TC17]

I am glad that someone feels the way I do. I could not agree with you more about the seeming lack of concern on this site about the possibility of progressing to a NW 6 or 7 level.

 

Dr. Beehener and Dr. Mohmand have probably posted the most examples of work done on NW 7's, and while there is a marked improvement, I too would not want such a hairstyle. Both Dr. Beehner and Dr. Mohmand do the best they can with those patients, but such a look is not for me.

 

What is most disconcerting to me is the fact that those patients are probably the future for many of us under the age of 35 who are experiencing hair loss. Sure, we see great results when a top physician transplants a 30 year old NW 5, but what happens when that 30 year old patient progresses to a NW 7 at age 50? Why is it that when a doctor works on a NW 7, he is almost always limited to the frontal forelock pattern, yet when a doctor works on a patient who may turn into a NW 7, such a pattern is not used? I look at patients like Drew35 who are in their mid 30's and already at a NW 6.5 pattern and just wonder what will happen in the next 10 or 15 years if further loss occurs? After all, Drew's hair loss is very aggressive for a 35 year old man, so wouldn't it stand to reason that he would be the type of patient who has a see through donor in his 50's? In my opinion, the term "safe zone" is a misnomer, as I see many men with donor thinning. (Drew, if you're reading this, please do not take offense to this. I am merely using you as an example of something that worries me because you are young.)

The simple fact of the matter is that I believe a number of patients on this site will look rather odd as they age and continue to lose hair and "permanent" grafts, and also show a large, long, and very visible scar.

 

Last, I believe I mentioned it before, but I also thought that Bill looked GREAT with a buzzed head. If not for his donor scar, I would tell him to rock that look all the time. If I could have a look similar to that, I'd be ecstatic. It looked so much thicker when it was buzzed down.

[HTHELP]

"What is most disconcerting to me is the fact that those patients are probably the future for many of us under the age of 35 who are experiencing hair loss. Sure, we see great results when a top physician transplants a 30 year old NW 5, but what happens when that 30 year old patient progresses to a NW 7 at age 50? Why is it that when a doctor works on a NW 7, he is almost always limited to the frontal forelock pattern, yet when a doctor works on a patient who may turn into a NW 7, such a pattern is not used?"

 

BINGO!!!!!!!!! I say this to myself all the time! Granted I think some will be fine (or more then fine) especially those w/o a history of balding in their families (although sometimes that doesn't matter either) and for those who have/had awesome donar and ideal characteristics.

 

The point about donar thinning isn't discussed enough either. Another excellent point. I think to some degree some of us are in awe of the "wow" results and just forget about the rest cuz thats the easy thing to do. It's almost like "hey look at the guy, he was worse off then me I can look like that as well". And yeah, maybe (if you are one of the select few to get the "wow" results...which is FAR from guaranteed) you can..but for how long, and what are your options then. (I can see LMS nodding his head..)

 

All that said, personlly the only other option i've considered(after weighing all the factors that you basically mentioned) is getting micropigmentation into the scar if I went with strip (after fue etc was placed in the scar as well). IF I knew for certain (or close to it) that it could yield a nice cosmetic result where the scar is bascially masked at a buzzed cut, then strip would once again be on the table. But I have to hear from any trustworthy sources (or see any examples first hand) that would make me comfortable with it. (sorry for getting off topic..)

 

Anyhow I would love for a Dr, on many of the points brought up here.

[js32]

You guys have hit on the exact question that I've been looking for! I'm 32, I'm already probably a NW 6 and I know I'll never have a full head of hair. I've always kept my hair really short because it was always thin, I've been losing it since I was 18, I was always big into sports etc... I went to Dr. Haber last year and to my surprise he thought I was a good candidate for a transplant. Still, I wasn't sold on it because I was going to have keep my hair longer to cover the scar and I'm just not interested in the thinning, longer hair look at 32. I'd rather buzz it but if I buzz now I just look completely bald up top and I agree that there's a big difference when you have some stubble. I've been wondering if anyone has gotten an FUE procedure to frame the face, get some thin coverage, and buzz it down to a 1. Is this a possibility? I'd love to hear some feedback.

[Drew35]

Having FUE done first will decrease your future yield.

 

If you want to shave your hair down to a #1 don't have any kind of a hair transplant and just shave your hair down to a #1.

 

If you are a NW 4 or higher I believe you should have strip done first and then FUE.

 

 

That's my plan. Max out with strip surgery and then use FUE in the future if I need to.

 

 

If you want to shave your head, just save your self the thousands of dollars, and don't get a hair transplant at all.

[TC17]

js32,

Your plan is pretty much the exact same as mine, and one that I believe is the best approach for every man under the age of 40. I have spoken with a few physicians about doing the same thing, and each has told me that it is not only viable, but very prudent as well.

 

Drew35,

 

I respectfully disagree with your assertion. As the B spot noted in this post earlier, having FUE done before strip does not decrease the total yield of grafts available. It WILL decrease the future yield that can be taken, but the same can be said of strip. Because grafts are a finite supply, if you remove any of them with any method, you deplete the supply that can be taken in the future. But, future yield and future supply are two different animals, and yield is not compromised if you go FUE first by anything other than a negligible amount. Since you can always go back and have strip done later if you choose, why would a young patient enslave himself to a lifetime of having a large scar on the back of his head if it is not necessary?