30M NW6(?) wanting HT

[Gatsby]

@webathon how old are you can I ask?

[webathon]

I will soon be 31. 

H&W just sent my consultation. They suggest 4k-4.5k grafts to fill in the hairline and mid scalp and anything left over will be put on the crown. They are recommending FUE though, which is against what everyone here is saying...so I'm a bit confused on this bit. No reason was given for choosing FUE as far as I can see in the e-mail. 

[deeznuts]

32 minutes ago, webathon said:

I will soon be 31. 

H&W just sent my consultation. They suggest 4k-4.5k grafts to fill in the hairline and mid scalp and anything left over will be put on the crown. They are recommending FUE though, which is against what everyone here is saying...so I'm a bit confused on this bit. No reason was given for choosing FUE as far as I can see in the e-mail. 

A consultation is just the starting point. You can always discuss with the doctor and see what they think about your situation or ask if you can opt for FUT

[webathon]

53 minutes ago, deeznuts said:

A consultation is just the starting point. You can always discuss with the doctor and see what they think about your situation or ask if you can opt for FUT

The consultation doesn't come from the doctor?

[Gatsby]

I don't mean to come across as dismissive in any way but you need to be asking a lot more questions at this stage. The consultation is done by the consultant. Make a time to speak to the surgeon about all the reasons of why they are choosing a plan for you. Don;t be in a rush until you know all the facts and have all of your questions answered. Keep posting them up here and with others, etc. All the best.

[deeznuts]

5 hours ago, webathon said:

The consultation doesn't come from the doctor?

Idk how Hasson and Wong does it. But you can always communicate with the rep and discuss your concerns

[Hair4Days]

H&W seem to think fue can be done in advanced nw patients. I was suggested fue as well, but they did include in the email that combining fut and fue yields a bit more grafts so it’s up to you 

[Curious25]

1 hour ago, James C said:

H&W seem to think fue can be done in advanced nw patients. I was suggested fue as well, but they did include in the email that combining fut and fue yields a bit more grafts so it’s up to you 

A patients suitability for FUE or FUT is dependent on the characteristics that they present with . . not their NW status. 

A NW6 with thick calibre hair, and a donor density of higher than 80FUcm2 would arguably be a better FUE candidate than a NW 3 with fine hair, and donor densities of 60FUcm2. 

 

[Hair4Days]

12 hours ago, Curious25 said:

A patients suitability for FUE or FUT is dependent on the characteristics that they present with . . not their NW status. 

A NW6 with thick calibre hair, and a donor density of higher than 80FUcm2 would arguably be a better FUE candidate than a NW 3 with fine hair, and donor densities of 60FUcm2. 

 

That makes sense. But In regards to maximizing yield..Would the same hypothetical  nw 6 with 80 fucm2 get front to back coverage with fue alone.  Some would argue he’s better off with strip first. But h&w is recommending fue to this patient who posted his photos and is a clear future Norwood 6. 

Edited August 20, 2021 by James C

[aaron1234]

I think a lot of clinics recommend FUE because they feel the patients will not want/need maximum lifetime grafts, probably one or two surgeries at the most, so why not avoid the strip scar altogether.  But I do feel strongly that the FUT+FUE=Max Lifetime Grafts approach needs to be explained to new patients regardless.

[Hair4Days]

5 minutes ago, aaron1234 said:

I think a lot of clinics recommend FUE because they feel the patients will not want/need maximum lifetime grafts, probably one or two surgeries at the most, so why not avoid the strip scar altogether.  But I do feel strongly that the FUT+FUE=Max Lifetime Grafts approach needs to be explained to new patients regardless.

I think it depends on how much coverage the patient can realistically get if they opt for 2 fue sessions. Personally, If i was able to frame the face with a dense frontal third, moderate density in the mid scalp and have it flair off into the crown with lighter coverage in the back then I’d without a doubt avoid the strip scar. I think that comes down to the Math though. Measuring the balding pattern and then calculating donor capacity. At that point you can literally map out how many grafts per square cm can go where 

[Curious25]

11 hours ago, James C said:

That makes sense. But In regards to maximizing yield..Would the same hypothetical  nw 6 with 80 fucm2 get front to back coverage with fue alone.  Some would argue he’s better off with strip first. But h&w is recommending fue to this patient who posted his photos and is a clear future Norwood 6. 

I've not actually looked at this particular patients case, I just saw your comment come up on the activity feed, so thought to chime in. 

In response to your question however - besides from the idea of 'front to back coverage' being subjective, it all depends on the individual. If the patient had thick calibre hair, and didn't mind not having >45FUcm2 across his whole recipient, then yea. Look at some of Dr Zarev's high NW cases, Eugenix also have quite a few from FUE alone, as do the spanish Wizards such as Lorenzo, Couto, and De Freitas. 

I think the strip first, then FUE after does still largely play true in terms of maximising lifetime grafts, from what I have read and watched most recently from leading doctors - however there is certainly a trend that is phasing away from FUT altogether, now FUE survival rates are comparable, and the market demand is more orientated towards lots of little scars, rather than one big linear one. 

FUE is also more expensive, so whether or not people are cynical enough to deem that as a reason surgeons are opting for FUE more so now, may also play a part. 

I'm an FUE patient myself, who takes no medication, and will probably hit at least NW5 eventually, and I am more than happy to just continue my HT journey throughout my lifetime with small FUE surgeries as and when. I have beard and chest hair to use, and pretty ok hair characteristics so I'm at peace . . however if a surgeon recommended me to go for an FUT procedure further down the line to help squeeze out more grafts for me, I would consider it. 

[InTheSix]

On 8/18/2021 at 8:55 PM, webathon said:

The consultation doesn't come from the doctor?

as @Gatsbysaid.. do a lot of research and ask a lot of questions.. things are not as 'black and white' nor linear as they may seem aka just because there is a notion that FUT before FUE yields more lifetime graft, doesnt mean that applies to all potential patient or situations... From personal experience, your initial feedback from H&W can just come from the consultant, based on their experience.. this doesnt however have to be the final word... You can share more information and have further conversation with the consultant or ask to get direct feedback from the docs.. again this doesnt mean that their recommendation will not change based on additional feedback, better pics or in person conversation... also know that Dr Hasson primarily now only focusses on FUE (at least thats what I was told) while Dr Wong does both (but of course he does a fair chunk of the clinics FUT's)... from personal experience, my communication with H&W was over several months/years, and between that time my prognosis evolved quite a bit.. I went from being a good candidate, to not so good, to good again, to FUT strongly recommended to FUT or FUE not making a big difference in my case... And the reason for differing opinion was simply more information (my preferences evolved, I shared better pics, I spoke to the consultant over the phone vs email, I had an in-person evaluation with the doc vs email)....while most clinics are good at giving decently accurate virtual recommendation, in my opinion nothing replaces an in-person doctor consultation... level of miniaturization, hair caliber, skin laxity, etc can all either further reinforce your initial recommended option, or slight shift favor to another (FUT vs FUE).. for example in my case, simply the fact that the lead tech involved in my HT was, in Dr Wong's opinion, "not just the best in North america, but perhaps the world", improved my FUE odds significantly (as her transection rates are minimal)...

best of luck..

[webathon]

I sent out more consultations to other providers. Still haven't heard back from H&W in regards to the questions I had and it's been over a week...