Does getting FUE done first decrease total yield?

[TC17]

Also, I am under the impression that when your hair is cut short to a certain level, it can appear fuller. I believe that Dr. Lindsey stated that when he buzzed his own head it looked much thicker, but as it grew back into the #3 level or so it began to appear thinner again. If that is indeed the case, then it stands to reason that a doctor can transplant fewer grafts, over a larger area, and give a cosmetically pleasing result, provided that the patient keeps his hair short. I'm not trying to overhype FUE, but in deeply considering the pros and cons associated with strip and FUE, I've decided that FUE wins convincingly for my goals and for my lifestyle.

[thanatopsis_awry]

I couldn't agree more. This is exactly would I often recommend younger guys do when they have bad donors + extensive loss (emphasis on the bad donor, though, since extensive loss can reveal itself at nearly any time).

 

He doesn't post her that much anymore, but "youngsuccess" was the first person that I ever heard advocate this approach...it was based off him seeing this pro soccer player who had an aberrant balding pattern that would more or less mimic what we would be looking like.

 

I still have some reservations about whether this route places a sacrifice on your ultimate ability to harvest as many grafts as possible (just based upon conflicting things I've heard from well-respected clinics).

 

But it gives you so much flexibility while buying ample time to evaluate future options.

 

It's pricier, potentially a lot pricier, but this way truly does merit serious considerations. To be frank....I might have gone this way had I known what I know now....

 

Right now I still deal with the occasional fretting over my scar; being pseudo-confined to being anal over how I style my hair; and already thinking over an imminent procedure to play catch-up. I feel like if I went this other route, I would not be dealing with *any* of these things. And, ironically, I think I look quite good when I buzzed my head post-op, and in shape + well dressed I'd be pretty curious about how good I'd feel that way.

 

A *non*-balded shaved head is a *radically* different thing than a dude with a legit hairline and seemingly decent coverage buzzing their head. The former actually can look ridiculously cool on a lot of people, especially if you work a certain look.

[TC17]

I think there is no question that doing FUE first sacrifices the ability to harvest as many grafts as possible, but I do not think that it is a high enough number to be of much importance. I realize that grafts are at a premium, but I believe that by allowing the person to keep his hair short, the loss in grafts associated with FUE is a moot point.

 

Those fears that you have thana, are the biggest reason why I have yet to undergo a transplant. I hear things like that, and I think to myself that the stressing, the worrying, the need to keep up with future loss, and the limitations on styling, are not worth it to me. I'd rather have 4,500 grafts done from FUE and keep the hair short, than have 7,000 from strip + FUE and deal with the angst that I know I would feel. Hell, I have more hair now than I'll ever have if I get a transplant, and I hate when my hair doesn't lay right. These are all deeply personal opinions, and if someone doesn't share the same concerns that I do, then I believe that they should STRONGLY consider strip, as it is more established and less costly.

 

I figure that when I get out of law school in two years and begin working, I will be in an office from 7:30am to 6:30pm on most nights. I'm really big into working out, but realize that after an 11 or 12 hour day, I will not want to hit the gym. But, since staying in shape is so important to me, I figure my best bet is to work out on my lunch break. I cannot imagine having to shower at the gym and then do my hair all over again before heading back to the office. I use a mirror now to check the sides, back, top, everything. Sometimes the hair looks good in 2 minutes, other days it looks OK after 45 minutes. I cannot imagine the embarrassment in going through my styling ritual in a public setting, no can I imagine what would happen if the hair is on one of those days where it seemingly takes forever to look OK. I can't risk going back to the office and meeting clients, or trying a case, conducting voire dire, anything really, without being confident. As it stands now, I believe that I will look and feel better if I have a nice hairline, and the frontal 2/3rds filled with FUE. I look forward to the day when I get out of the shower, dry the hair, and hit the road.

 

- thana, clarify your last statement. when you say "non balded shaved head", are you thinking of like brad pitt in fight club? how does the "non balded shaved head" contrast with "legit hairline and seemingly decent coverage"? i'm not understanding how they're "radically" different?

[js32]

TC17, you mentioned that you've talked to a few physicians about the approach that you and I are considering...could you tell me who they are? You seem to know a lot more about this stuff than I do, do you know of any reputable FUE clinics in or around the midwest??? I'm in Ohio and would like to consult with someone who does the FUE, I've already done the strip consultation and I know that's not for me at this point.

Thanks

[thanatopsis_awry]

Just mean that "we" sometimes just tell guys to do bicep curls and shave their head; shaving the head is the cool thing to do these days....I actually think this advice carries some truth and non-truth. The truth is that the shaved head *is* in...and it *can* look good (very good). A' la Brad Pitt in fight club....or pretty much any non-MPB guy who shaves his head, is in solid shape, etc.

 

That's what I'd consider "legit hairline/decent coverage"-shaved head; I'd contrast this with the look of people who have untreated MPB and shave there head. Particularly, when they lack the outline of a hairline.

 

IMHO, a lot of the time it's just lateral movement....if not backwards movement...in terms of the look people get, and actually ridding ourselves of the "bald aesthetic", which is ultimately we want...distance ourselves from the self and societal induced stigmas and emotions of losing our hair....but ya, with even a modest FUE session to establish an artistically designed hairline and such, geared towards structuring a nice look for a guy to buzz down....I think this can and does make a world of difference. I'm especially curious how an intelligent doc would go about such an FUE session with this in mind.....

 

Personally, when I buzzed my head post-HT, especially once I got the length right and the scar concealed, I looked infinitely better than when I had tried buzzing my hair pre-HT.

 

Anyways, I do totally agree with you...and think the two camps are go about a route as detailed by yourself, or max yourself out and go for it by way of strip + FUE....essentially, the latter is what I've signed up for...for me personally, I'm still pretty confident; but if I had worse donor....even just mediocre donor....

 

I like the route you'll be taking, and it seems optimal for your lifestyle. (and I honestly think it's a route that'd be extremely appealing to most any younger guy....cost being the main drawback; but, let's be real, if your young and get a HT you basically better have the financial means to back up a series of HTs to achieve a boatload of grafts...and likely less grafts than you'd need to go the FUE route, so...)

 

edit -- btw, js, some of the top strip clinics have also expanded into mastering FUE, and offering both options to patients; likewise, there are "FUE clinics" who just do that, whom I don't trust at all. I'm a joke with geography, but I think SMG (shapiro medical group) is in Minnesota, and I think that'd be your closest and best bet...as always, though, don't let geography totally dictate your decision, and you should do several FUE consults (off the top of my head I'd recco SMG and Feller in the U.S....there are more docs offer it, but I believe that within the U.S. those two stand at the vanguard of keeping on top of FUE and its rapid evolution...Feller, of course, recently came out with a new tool designed to further enhance FUE)

[HTHELP]

I couldn't agree more with TC and thana. I think people should take a close look at what thana siad above. This is coming from someone who's experienced an awesome result via strip YET may have done things differently in hindsight.

 

I for one started thinking about getting an HT 5 years ago when I was 25. Had I gone through with it there is no doubt in my mind that I would now be playing th" catch-up" game and married to a comb over type hairstyle for the rest of my life (which I fear the case will be for many ht patients in general...especially the younger ones who's hairloss patern is not yet defined. It kills me when I see these guys who have so little hairloss yet they decide to go through with life changing surgery). When someone questions it I see the responses ranging from agreement to "everyone has different goals, and this level of hairloss may bother them and not you". I can't help but shake my head at that.

The "I want it all NOW" mentality (isn't that what got us / this country in the financial mess we are in) is short sighted to say the least.

 

I'd still love to hear from smg,feller,Lindsey or any doc for thet matter regarding what level of density (appx) would be needed to pull of the buzzed look. I'm hoping to set up a consult with dr. Feller since I'm in ny (no luck so far with the receptionist). I'll circle back with you TC if/ when that happens.

[TC17]

Check out abby's hair transplant with Dr. Mohmand. He was pretty bald, had 3200 grafts placed over a rather large area, and looked VERY good when it was buzzed down. Of course, because he had a strip procedure, he could not keep his hair like that, but I was still very intrigued with the possibilities. If he could achieve that with 3200, what could I do with 4,000? I do realize that comparing one patient to another is an exercise in futility, but I think that because his hair was so short, the individual characteristics that influence a transplant were lessened to some degree. I could be wrong, but regardless, the fact of the matter is that when hair is buzzed down it looks thicker.

 

js32, I'm in Ohio too, if you want, you can send me a PM and if I can ever help you out with anything I'd be happy to.

[TC17]

This is a link to Abby's weblog. http://www.hairtransplantnetwo...e-page.asp?WebID=753

The 9 month results are nothing short of amazing. I think that his grown out results at 15 months also looks very good, but you can clearly see that it appears thicker at 9 months when the hair is sort. Granted, because he is 3.5 months removed from a second surgery of 2,000 grafts he will thicken considerably in time, but if he had undergone FUE the first time would the second surgery even have been necessary?

 

I would say that it looks as though 175cm of bald area was covered. If Dr. Mohmand or Abby could give us details or clarify, I would appreciate it greatly. If it is 175cm, then the uniform density would average out to be a little over 18 FU's per cm, quite a low number, yet quite a nice result. Even if it is only 100cm (which it looks far greater than), the uniform density would still "only" be 32 FU's per cm. Again, a much lower number than what is commonly thought of as needed to achieve a nice result.

 

To me, in the face of an uncertain future, it is imperative that we retain as many options as possible. I think that we should all plan as though medications will cease working, and that no "cure" will ever be found. Planning for the future based upon the hope that cloning will render donor issues moot, or that meds will always work, is nothing short of insanity, and potentially malpractice on the part of the physician. Our hair restoration plans should be based upon proven methods and technologies, and not on pipe dreams and hopes of what may be. That way, even if cloning never becomes viable, and the meds lose the battle, we do not look like freaks. It's one thing for a man to be bald, that's normal, it's quite another for a man to look ridiculous.

[splitting hairs]

I don't think that doing FUE first reduces your yield (other than the 5%, since strip has 95% yield and FUE 90%).

 

Think of it this way, doing FUE first, lets say - 1000 grafts. Generally, that's over a LARGER area, however, as a result, your donor density is reduced. Doing strip afterwards would mean you remove grafts in a small 1-2cm strip across the back of the head, but get less grafts because some have already been removed (lets say you get 1600 vs 2000).

 

So essentially, you've got the same number of grafts(other than the 5% and those extra grafts outside the strip region). Except you've had an extra procedure which costs way more. So as long as you don't mind spending the extra cash, it should be OK. Plus it has the advantages you guys have already mentioned.

[the B spot]

TC---the thing that patients of middle eastern descent have over most others is very coarse, thick individual follicles and most have very low hair to skin contrast.

 

This makes less density necessary to achieve these results.

 

For a Caucasian, with average hair characteristics with the idea of buzzing short, wanting a hairline to frame the face coupled with overall coverage for 100-120cm of coverage would be as follows(IMO)

 

Hairline Density 35 single FU's followed by a density of 25 throughout and the final cm as one would go into the crown about 15.

 

About 3200-3500 grafts for 120-130cm of bald area.

 

My guess is this would be done with the idea of the potential for leaving the crown bald, unless #1--the patient is satisfied with the look after HT#1 #2 they have plentiful donor that allows the necessary 1500-2000 additional grafts to give the crown some coverage.

 

I think if after a HT is performed, if the patient kept up a nice base tan--to reduce scalp/hair contrast---this would look fantastic.

 

Jason

[TC17]

Jason,

 

Does the thick, coarse hair matter when the hair is cut short? I can understand how it would affect matters when grown out, but I would think that when the hair is cut short, that the differences between thick and thin would be minimized. Is that not the proper belief?

 

Also, based upon your estimates of 3,500 grafts for 130cm, I came up with 5,385 grafts for 200cm, for an average density of 29 FU's per sq cm. Does SMG believe that the average patient can get 5,000 grafts from FUE alone?

 

Last, can the surgeon consciously choose to extract only multi unit grafts for use in the back 2/3rds? If that is done, wouldn't you be able to achieve greater density with fewer grafts?

[the B spot]

Yeah, the hair matters even when it is short---but do not discount the scalp to hair contrast either--it all works to a large degree to complete the "look"----thick coarse hair is just fantastic for covering the scalp.

 

I (my opinion) think most guys have 3-4K available through FUE BEFORE the doctor must take a very hard, close look at the impact on the donor. As I have said, there will be freaks of nature who have unlimited donor resources and yet others who will be limited to 2-3K. The point is do 2000-2500 grafts, look at the donor and try to gauge any scarring, any gaps, etc... then proceed carefully. I think 5K can be done, just not in 1 session, and with the possibility of some gaps/white dots at a low buzz. Again, just like a strip scar is an acceptable trade off, this may be an acceptable trade off for those looking for FUE.

 

I think if your doing smaller sessions, yes. Like 1200-1500 grafts---just by extracting properly from the donor, the average patient will yield mostly 2 hair grafts---if a doctor felt he/she needed 100 3-4 hair grafts for density, sure. You need to extract in an irregular pattern, and as low of a % as possible through the entire donor as to evenly take from the region, so it does limit excessively going for larger grafts.

 

To add another point-- you would want mostly 1-2-3 hair grafts only to do the approach we have discussed. The idea is total coverage, specific density throughout, while maintaining a short/buzz cut look....

 

Cheers,

Jason