Has FUE Taken Over?

[Melvin- Admin]

I remember when I started on this forum there was a heated debate over FUT vs. FUE, it was deemed that FUT was the gold standard. A look back at the ISHRS census ten years ago shows that to be true

However, in less than 10 years FUE has managed to jump from 22% to 66% a staggering difference. 

The new ISHRS conference is this month, so we shall see what the new numbers are for 2021, but I’d venture to say FUE will be around 70% of all hair transplants performed last year. Thoughts? 

[RandoBrando517]

This aint even debatable  

[LaserCaps]

No, I don't think so.  

I call the FUE the glorified technique. If you think about it, this has been around since the 50's! Do you remember the plug? Same issue but a log bigger punch.  Now its' more refined...which brings another issue.

I think most understand that a punch .9mm or less will leave no visual scar.  There are scars, mind you, but so small that the naked eye can't pick them up.  And, the smaller the punch, the less "meat" around the follicle.  So chances for damage is greater.

FUT, heartier grafts.  

I think both have their pros and cons but both can be used depending on the goals of the patient.  If military and can not afford to have a scar - FUE.  If you are going to leave the hair long, perhaps FUT would be a better option.  In subsequent procedures the doctor will typically re-excise the original scars so there is always one remaining.  Eventually there will be no more give.  When this happens the patient can then choose FUE.  This way the patient has access to the entire donor area.  

[JDEE0]

 

4 minutes ago, LaserCaps said:

No, I don't think so.  

I call the FUE the glorified technique. If you think about it, this has been around since the 50's! Do you remember the plug? Same issue but a log bigger punch.  Now its' more refined...which brings another issue.

I think most understand that a punch .9mm or less will leave no visual scar.  There are scars, mind you, but so small that the naked eye can't pick them up.  And, the smaller the punch, the less "meat" around the follicle.  So chances for damage is greater.

FUT, heartier grafts.  

I think both have their pros and cons but both can be used depending on the goals of the patient.  If military and can not afford to have a scar - FUE.  If you are going to leave the hair long, perhaps FUT would be a better option.  In subsequent procedures the doctor will typically re-excise the original scars so there is always one remaining.  Eventually there will be no more give.  When this happens the patient can then choose FUE.  This way the patient has access to the entire donor area.  

I would have to disagree with most of this....

I don't think it's fair to call FUE a glorified technique; maybe amongst those who think they know about HT's but then go and pick a hair mill in Turkey, then yeah, these sorts of people may glorify it and dismiss FUT as some kind of archaic technique. Amongst actual respected doctors and educated patients, though, it is clear that both FUE and FUT have their pros and cons and that one or the other is often more suitable for a certain type of situation/candidate. I also think comparing plug surgery to modern FUE is like comparing an old Commodore 64 to a brand new PC... they're both computers, but the similarities start and stop there.

Mainly though, I wanted to say that it is very inaccurate to state that a punch of .9mm or less will not leave visual scars to the naked eye. In a small percentage of patients, you are somewhat correct as it can be nearly undetectable even when shaved to the bone (nearly being key here). But in reality, the vast majority will fall in the middle somewhere where it will very much be visible to the naked eye when shaved down, even at half or no.1 guards probably, and then there's the few who fall into the unlucky category and will have very very very visible scarring due to their own physiology/healing. 

As for FUT grafts being heartier, I would actually argue the opposite is true as you can pick and choose whatever grafts you want with FUE. If you want to chase after multi's then you can do (within reason of course). With FUT, you get whatever you get from the strip. In addition, we've had numerous top class surgeons such as Bisanga  come on and confirm that at this point that, under adequately trained hands, FUT is no more viable or successful than FUE anymore. One isn't better than the other in terms of success of harvest.

I think it just comes down to preference and necessity. If you must have the option to wear your hair short, then FUT probably isn't the best idea. If you hate the idea of the linear scar, don't have aggressive baldness and so on, FUT probably isn't the best idea. If you conversely do have aggressive loss and a limited donor, then you should probably maximise grafts via FUT and so on.

 

 

[Melvin- Admin]

23 minutes ago, LaserCaps said:

No, I don't think so.  

I call the FUE the glorified technique. If you think about it, this has been around since the 50's! Do you remember the plug? Same issue but a log bigger punch.  Now its' more refined...which brings another issue.

I think most understand that a punch .9mm or less will leave no visual scar.  There are scars, mind you, but so small that the naked eye can't pick them up.  And, the smaller the punch, the less "meat" around the follicle.  So chances for damage is greater.

FUT, heartier grafts.  

I think both have their pros and cons but both can be used depending on the goals of the patient.  If military and can not afford to have a scar - FUE.  If you are going to leave the hair long, perhaps FUT would be a better option.  In subsequent procedures the doctor will typically re-excise the original scars so there is always one remaining.  Eventually there will be no more give.  When this happens the patient can then choose FUE.  This way the patient has access to the entire donor area.  

Comparing modern day FUE to the black and decker from the 50s is ridiculous. It’s like saying mini-grafts are the same as FUT. It may be a variation, but the overall technique is night and day.

Now, punch size is a completely different argument. Factually speaking, looking at the stats, it’s definitely more popular, whether it’s better is another discussion and topic. 

[Britanium]

I think the stats will be more than 70% for FUE.. I find it very interesting that combo cases are on the increase. I have always thought it’s a excellent option combining FUT/FUE ! BHR do this so well. 
FUT isn’t outdated yet, although I think it’s use will continue to decline year on year. Let’s be honest here apart from maybe Hattingen it’s mostly US clinics that still perform FUT and even then we are seeing more FUE cases over FUT. 

On the surface it’s FUT that appears the more antiquated technique being that it’s actually taking a strip of your skin from the back of your head. I still think it has its place for higher Norwoods. But clinics like Eugenix are showing what’s possible be using FUE and Beard grafts, even in the highest of Norwood levels.

[Curious25]

2 hours ago, LaserCaps said:

No, I don't think so.  

I call the FUE the glorified technique. If you think about it, this has been around since the 50's! Do you remember the plug? Same issue but a log bigger punch.  Now its' more refined...which brings another issue.

I think most understand that a punch .9mm or less will leave no visual scar.  There are scars, mind you, but so small that the naked eye can't pick them up.  And, the smaller the punch, the less "meat" around the follicle.  So chances for damage is greater.

FUT, heartier grafts.  

I think both have their pros and cons but both can be used depending on the goals of the patient.  If military and can not afford to have a scar - FUE.  If you are going to leave the hair long, perhaps FUT would be a better option.  In subsequent procedures the doctor will typically re-excise the original scars so there is always one remaining.  Eventually there will be no more give.  When this happens the patient can then choose FUE.  This way the patient has access to the entire donor area.  

I find it hard to believe you're a rep because you don't half spout a lot of nonsense on these boards. 

[Melvin- Admin]

1 hour ago, JDEE0 said:

 

I would have to disagree with most of this....

I don't think it's fair to call FUE a glorified technique; maybe amongst those who think they know about HT's but then go and pick a hair mill in Turkey, then yeah, these sorts of people may glorify it and dismiss FUT as some kind of archaic technique. Amongst actual respected doctors and educated patients, though, it is clear that both FUE and FUT have their pros and cons and that one or the other is often more suitable for a certain type of situation/candidate. I also think comparing plug surgery to modern FUE is like comparing an old Commodore 64 to a brand new PC... they're both computers, but the similarities start and stop there.

Mainly though, I wanted to say that it is very inaccurate to state that a punch of .9mm or less will not leave visual scars to the naked eye. In a small percentage of patients, you are somewhat correct as it can be nearly undetectable even when shaved to the bone (nearly being key here). But in reality, the vast majority will fall in the middle somewhere where it will very much be visible to the naked eye when shaved down, even at half or no.1 guards probably, and then there's the few who fall into the unlucky category and will have very very very visible scarring due to their own physiology/healing. 

As for FUT grafts being heartier, I would actually argue the opposite is true as you can pick and choose whatever grafts you want with FUE. If you want to chase after multi's then you can do (within reason of course). With FUT, you get whatever you get from the strip. In addition, we've had numerous top class surgeons such as Bisanga  come on and confirm that at this point that, under adequately trained hands, FUT is no more viable or successful than FUE anymore. One isn't better than the other in terms of success of harvest.

I think it just comes down to preference and necessity. If you must have the option to wear your hair short, then FUT probably isn't the best idea. If you hate the idea of the linear scar, don't have aggressive baldness and so on, FUT probably isn't the best idea. If you conversely do have aggressive loss and a limited donor, then you should probably maximise grafts via FUT and so on.

 

 

I truly believe there will always be a place for FUT, it’s still a viable technique. But facts are facts, it’s severely waning in popularity, there’s two reasons. Number one, the obvious medical tourism affecting the industry, but the second and most vital reason is that FUE results have improved tremendously since 2010. 

The fact that the ISHRS had a specific question that asked surgeons the percentage of patients they convinced out of getting FUE should tell you everything about the state of FUE at the time. 

 

I believe there’s some merit to meatier chunkier grafts, but that’s not everything. Implanter pens, stick and place, DHT techniques, I feel have made a tremendous difference as well. There’s definitely a benefit of going FUT first if you’re a high Norwood, but cutting your hair short is out of the question, as clinics like Eugenix push the envelope on what’s possible with FUE, the more popular it will become. I foresee FUT becoming a niche technique. Hopefully surgeons still learn how to do it, but it will be reserved for specific cases. 

[asterix0]

Well, think about it like this. Imagine you have an unlimited budget and can see any surgeon in the world. What procedure and surgeon do you pick?

I think certainly, as medical technology and surgeon skill continues to improve, FUE will almost entirely replace FUT soon enough.

Edited October 6, 2021 by asterix0

[aaron1234]

4 hours ago, Melvin- Moderator said:

I foresee FUT becoming a niche technique. Hopefully surgeons still learn how to do it, but it will be reserved for specific cases. 

I hope so too - otherwise guys like me in the future will have run out of grafts before having the opportunity to address their crowns. 

[Melvin- Admin]

22 minutes ago, aaron1234 said:

I hope so too - otherwise guys like me in the future will have run out of grafts before having the opportunity to address their crowns. 

To be honest, it seems to be a real problem. Very few new surgeons are learning strip. Beyond that though, finding technicians who can sliver grafts is becoming harder and harder. There needs to be a conscious effort in the future. 

It’s like driving manual. My first car was a manual, so I learned how to drive manual and most of my cars except recently were manual. But these new kids growing up now don’t have a clue about manual and won’t know how to drive manual. Unless there’s a conscious effort FUT could become obsolete in the same way.

[Britanium]

1 minute ago, Melvin- Moderator said:

To be honest, it seems to be a real problem. Very few new surgeons are learning strip. Beyond that though, finding technicians who can sliver grafts is becoming harder and harder. There needs to be a conscious effort in the future. 

It’s like driving manual. My first car was a manual, so I learned how to drive manual and most of my cars except recently were manual. But these new kids growing up now don’t have a clue about manual and won’t know how to drive manual. Unless there’s a conscious effort FUT could become obsolete in the same way.

In recent years I can think of Dr Bloxham getting trained and using FUT, but who else ? 

[Melvin- Admin]

Just now, JohnAC71 said:

In recent years I can think of Dr Bloxham getting trained and using FUT, but who else ? 

Not many, Dr. Nadimi knows, and so does Dr. Shaver, but beyond that I can’t think of many. 

[Britanium]

1 minute ago, Melvin- Moderator said:

Not many, Dr. Nadimi knows, and so does Dr. Shaver, but beyond that I can’t think of many. 

Just can’t see it being used much at all in say 5 years if those stats keep increasing for FUE… 

[Melvin- Admin]

Just now, JohnAC71 said:

Just can’t see it being used much at all in say 5 years if those stats keep increasing for FUE… 

Here’s another BIG reason why FUE has grown in popularity. The biggest age demographic for hair transplants has always been 30-49 years. This age demographic is changing, 10 years ago someone who was 49 at the time is now 60. Baby boomers 10-20 years ago we’re still the biggest demographic, but now it’s millennial and gen x. Both groups have grown up with short hair. 

[Britanium]

Just now, Melvin- Moderator said:

Here’s another BIG reason why FUE has grown in popularity. The biggest age demographic for hair transplants has always been 30-49 years. This age demographic is changing, 10 years ago someone who was 49 at the time is now 60. Baby boomers 10-20 years ago we’re still the biggest demographic, but now it’s millennial and gen x. Both groups have grown up with short hair. 

True, and I can’t see them being attracted to having what is really a older and more invasive method. Everyone wants to be as scar free as possible. Even the advertising for a lot of clinics is “Scarless FUE/DHi etc” which is of course nonsense. 

[aaron1234]

11 minutes ago, Melvin- Moderator said:

To be honest, it seems to be a real problem. Very few new surgeons are learning strip.

Most definitely.  A new HT surgeon's perspective is likely, "Why learn strip when 95% of prospective patients are asking for FUE?"

[Britanium]

Even in the Uk we have seem to have migrated in to FUE procedures, 10 years ago FUT dominated. 5 years ago it was changing. 

[Melvin- Admin]

12 minutes ago, aaron1234 said:

Most definitely.  A new HT surgeon's perspective is likely, "Why learn strip when 95% of prospective patients are asking for FUE?"

Let’s face it from a business standpoint FUE makes more sense. No one is going to pay $10 per graft for FUT. 

[Britanium]

Right now people seem to prefer paying more £€$ for FUE, from what I can see just about all of the Drs/Clinics are cheaper for FUT. 

[Gatsby]

Today surgery is definitely more in favor of FUE over FUT. Personally I believe that this is being driven by consumer demand and the ability of surgeons to out source the work to cheap paid techs in many places, this allows many start up clinics to allow the doctor to perform (oversee) a number of surgeries in the one day. You can see this occurring in places like India and Turkey. However this does not reflect best practice if a good strip doctor can yield more grafts via FUT and later on follow this up with FUE.

[Raphael84]

Always a hot topic for debate and we will all have our own preferences and perspective regarding such techniques. Some interesting points made. 

10 hours ago, Melvin- Moderator said:

Here’s another BIG reason why FUE has grown in popularity. The biggest age demographic for hair transplants has always been 30-49 years. This age demographic is changing, 10 years ago someone who was 49 at the time is now 60. Baby boomers 10-20 years ago we’re still the biggest demographic, but now it’s millennial and gen x. Both groups have grown up with short hair. 

Very much agree with Melvins point above. I believe that this also down to the pressures of always looking your best due to social media and IG and the constant digital world that we now live in. Everything is media and photograph related nowadays and the younger generation do now know any different. 

10 hours ago, Melvin- Moderator said:

To be honest, it seems to be a real problem. Very few new surgeons are learning strip. Beyond that though, finding technicians who can sliver grafts is becoming harder and harder. There needs to be a conscious effort in the future. 

It’s like driving manual. My first car was a manual, so I learned how to drive manual and most of my cars except recently were manual. But these new kids growing up now don’t have a clue about manual and won’t know how to drive manual. Unless there’s a conscious effort FUT could become obsolete in the same way.

Also agree. 
Below is copied from a previous post based on a similar discussion but potentially was more pricing related.

“Newer” doctors who may have “arrived” in the industry in recent years may not feel that it worthwhile to invest and dedicate x amount of years to really learn the intricacies of FUT due to the “dying” demand, which is understandable, and certainly one reason why FUT will continue to phase out each year. Such doctors would prefer to invest this time into improving their craft in FUE. However in doing so, it is fair to say that they will have a different understanding and potential limitations in serving each patients individual needs.

I feel that any doctor who may say that FUT provides better yield, they are speaking about their own experience and in their own hands. Leading FUE surgeons who have been in the industry for a long time and have much experience with FUT and FUE, generally have another view. FUE in the hands of a skilled surgeon produces optimal yield inline with FUT.

Considering the evolution of FUE over the last 5 - 10 years, very few patients now request or are even open to the idea of FUT surgery, with its more invasive nature, longer healing and recovery and of course the linear/strip scarring.

Therefore due to such a shift, the majority of hair restoration clinics have had to evolve with the times, and with the preference and demands of their patients.

Initially when FUE was introduced, it was more expensive than FUT due to the time demands of the doctor who would have had to invest significant time to learn the complexities of punching on patients with different hair characteristics and skin types.

FUE demands that the doctor(at least in reputable clinics) to personally punch each and every graft and to cut each recipient site, meaning a much greater demand on their time in comparison to FUT. Another very important point is that an FUE surgery may require only 3 technicians.

With FUT, the doctor will excise and suture the strip and prepare recipient sites. Depending on the graft count(FUT surgery is generally always a significant graft count), a patient may require 6+ technicians, to dissect, clean and appropriately sort and store grafts before beginning to place. FUT is very technician reliant with more demands time wise on the team over the doctor.

Just as “newer” doctors may not see the value in investing their time into learning to perform FUT, the same applies to technicians/nurses. This means that in general, a smaller percentage of technicians have training and experience in the technicalities of FUT surgery, meaning staffing FUT surgery can be also be a challenge for many clinics.

The reality of this, is that with FUE  “leading” the market over FUT, clinics no longer require the same quantity of technicians as they once did as the vast majority of patients decide to proceed with FUE surgery. When FUT is scheduled, more technicians are required, meaning more expense to be covered, which will be absorbed into the cost of surgery for the patient, oftentimes meaning that FUT may now present a higher price than FUE, and is no longer the more economical option, which in turn results in FUT becoming even less attractive to many.

[Melvin- Admin]

2 hours ago, Raphael84 said:

Always a hot topic for debate and we will all have our own preferences and perspective regarding such techniques. Some interesting points made. 

Very much agree with Melvins point above. I believe that this also down to the pressures of always looking your best due to social media and IG and the constant digital world that we now live in. Everything is media and photograph related nowadays and the younger generation do now know any different. 

Also agree. 
Below is copied from a previous post based on a similar discussion but potentially was more pricing related.

“Newer” doctors who may have “arrived” in the industry in recent years may not feel that it worthwhile to invest and dedicate x amount of years to really learn the intricacies of FUT due to the “dying” demand, which is understandable, and certainly one reason why FUT will continue to phase out each year. Such doctors would prefer to invest this time into improving their craft in FUE. However in doing so, it is fair to say that they will have a different understanding and potential limitations in serving each patients individual needs.

I feel that any doctor who may say that FUT provides better yield, they are speaking about their own experience and in their own hands. Leading FUE surgeons who have been in the industry for a long time and have much experience with FUT and FUE, generally have another view. FUE in the hands of a skilled surgeon produces optimal yield inline with FUT.

Considering the evolution of FUE over the last 5 - 10 years, very few patients now request or are even open to the idea of FUT surgery, with its more invasive nature, longer healing and recovery and of course the linear/strip scarring.

Therefore due to such a shift, the majority of hair restoration clinics have had to evolve with the times, and with the preference and demands of their patients.

Initially when FUE was introduced, it was more expensive than FUT due to the time demands of the doctor who would have had to invest significant time to learn the complexities of punching on patients with different hair characteristics and skin types.

FUE demands that the doctor(at least in reputable clinics) to personally punch each and every graft and to cut each recipient site, meaning a much greater demand on their time in comparison to FUT. Another very important point is that an FUE surgery may require only 3 technicians.

With FUT, the doctor will excise and suture the strip and prepare recipient sites. Depending on the graft count(FUT surgery is generally always a significant graft count), a patient may require 6+ technicians, to dissect, clean and appropriately sort and store grafts before beginning to place. FUT is very technician reliant with more demands time wise on the team over the doctor.

Just as “newer” doctors may not see the value in investing their time into learning to perform FUT, the same applies to technicians/nurses. This means that in general, a smaller percentage of technicians have training and experience in the technicalities of FUT surgery, meaning staffing FUT surgery can be also be a challenge for many clinics.

The reality of this, is that with FUE  “leading” the market over FUT, clinics no longer require the same quantity of technicians as they once did as the vast majority of patients decide to proceed with FUE surgery. When FUT is scheduled, more technicians are required, meaning more expense to be covered, which will be absorbed into the cost of surgery for the patient, oftentimes meaning that FUT may now present a higher price than FUE, and is no longer the more economical option, which in turn results in FUT becoming even less attractive to many.

Excellent points. As someone who’s had both, what was the main difference for you as a patient?

[Raphael84]

Thanks for the question Melvin. 

My personal experience Melvin is that they were really quite different.
Obviously different techniques, different clinics and ten years apart so I was expecting a different experience, but in all honesty it was quite vast.

Obviously FUE is much less invasive. FUT was an overall "heavier" surgery in terms of anaesthetic, discomfort during surgery with my body feeling heavy and numb, I left the clinic feeling quite nauseous. Sleeping was more problematic with a strip as to be expected and having stitches removed two weeks later was again another responsibility that was necessary. 
I experienced a lot of shock loss in my first surgery. Throughout my entire recipient and in areas around the strip which was hard.

FUE on the other hand despite two surgery days and also despite using beard as well as scalp was much "easier". Anaesthetic injections still weren't "fun", but other than that the days were more comfortable and post surgery it was just a matter of following post op instructions and working the scabs off. I didn't experience any shock loss this time round and other than wanting some length to hide the strip, there really wasn't any concerns.
 

[RandoBrando517]

10 hours ago, Raphael84 said:

Thanks for the question Melvin. 

My personal experience Melvin is that they were really quite different.
Obviously different techniques, different clinics and ten years apart so I was expecting a different experience, but in all honesty it was quite vast.

Obviously FUE is much less invasive. FUT was an overall "heavier" surgery in terms of anaesthetic, discomfort during surgery with my body feeling heavy and numb, I left the clinic feeling quite nauseous. Sleeping was more problematic with a strip as to be expected and having stitches removed two weeks later was again another responsibility that was necessary. 
I experienced a lot of shock loss in my first surgery. Throughout my entire recipient and in areas around the strip which was hard.

FUE on the other hand despite two surgery days and also despite using beard as well as scalp was much "easier". Anaesthetic injections still weren't "fun", but other than that the days were more comfortable and post surgery it was just a matter of following post op instructions and working the scabs off. I didn't experience any shock loss this time round and other than wanting some length to hide the strip, there really wasn't any concerns.
 

So pretty much FUE is better