Is FUT for graft maxing outdated advise

[Bandit90]

I’m quite knew to the Hair Restoration Network. But one thing I have found  alarming is the number of posters that tell often quite young & naive, higher Norwood patients who post on here for the first time seeking help, that they should undergo an FUT procedure in order to maximise grafts.
 

With recent advancements in FUE + BHT combinations surgeries, should people not be encouraging this as a first line surgical approach for graft maxing, as opposed to undergoing a much risker FUT procedure? 

This is purely my take on the situation. I may be completely off the mark. Appreciate every patient is different, but to me it feels that some posters are giving outdated, counterproductive advise. 

 

[1978matt]

https://www.ishrs-htforum.org/content/htfi/29/5/local/front-matter.pdf

"Conclusion: More hair and grafts were obtained using combination FUT followed by FUE than by either
technique alone. Although many practitioners feel that using FUE only can take care of the hair loss needs of
most patients, there may yet be a population of patients who will benefit from the ability to harvest a higher
number of grafts. It is important for hair transplant surgeons to have options available to give patients maximal
donor if desired."

[Britanium]

It’s important that people are given options on what is available, FUT is still being done (albeit less) and it still has its place for some individuals. Those with a poor donor area can still benefit from having FUT first. Or as it’s being done by Dr Bisanga and Medispa, combo hts can be used if needed. It really depends on the person. It’s important that it’s given serious consideration though as the inherent strip scar isn’t for everyone. Still some really good FUT work being done (mostly US) H+W, Hattingen, Bloxham for example. 

Edited April 8, 2022 by J.A.C

[BurnieBurns]

FUE + BHT has become a very viable option for some if gone to a clinic which specialises in this like Eugenix, Dr Umar, or Mwamba. There are many factors involved in each case as you say. 

Some points to consider:

- One might have very fine hair calibre with high skin to hair contrast and may need triple the graft yield of someone with thick hair and little contrast

- Their donor ma be thinned out from previous FUE done badly.

- Their body or beard hair may be different in colour or texture from their scalp hair and struggle to blend in with native hair

- Body hair may be very spare in some candidates.

- A candidate may have retrograde alopecia and the 'safe zone' is reduced. It is in their interest to take 100% of the hairs from their most DHT resistant area

- Ultimately (invasiveness of the procedure aside) it all comes back to if they mind the scar or not. Some just don't.

- Scalp grafts are still superior to beard or body grafts in terms or appearance and survivability.

As for the risks involved? Put it this way - a patient is a hell of a lot safer in the hands of a skilled and renowned FUT surgeon than a Turkish FUE hair mill!

Edited April 8, 2022 by BurnieBurns

[NARMAK]

I think FUT has a place in hair transplants and shouldn't be ignored. 

Usually FUE is made popular and many myths created around it as well as lies perhaps against FUT by calling FUE methods scarless etc. 

If you are a high Norwood guy, then FUT is a sensible consideration imo and then you can maximise with FUE and BHT. 

[Rahal Hair Transplant]

Bandit,

As already suggested above, those looking to maximize the number of follicular unit grafts available for transplanting are probably best starting with the FUT / strip method followed by FUE. However, one should “strip out“ prior to moving on to FUE in order to maximize the number of grafts you can achieve with FUT.   In other words, get as many FUT procedures as possible over the course of a couple years prior to moving onto FUE.

Some people have asked why it’s not the best to start with FUE and then finish off with FUT. Simply put, the reason for this is because when hair is extracted using the FUE method, it causes some damage to the tissue connected to the surrounding natural hair follicles.  As a result, this makes them fragile and not the best for transplanting in subsequent procedures. This is fine if you are sticking with the FUE method. But if you move onto FUT, an entire strip of tissue is removed and many of the grafts within the strip contain damaged tissue from the FUE…thus, making them ineligible for transplanting.

I hope this helps.

Rahal Hair Transplant 

[Rahal Hair Transplant]

I also want to add that most individuals can achieve a large number of follicular units via FUE alone and don’t have to request  both procedures.

Now if you compare the procedures individually because you want to know which of the two procedures as a standalone donor excision technique can provide more eligible hair for transplanting over the long term, I would say it depends.

In general, I would say that they are very comparable and those who choose FUE can obtain just as many grafts as they could if they had underwent FUT.  That said, there will be some cases where FUE will provide a greater number of grafts and in other cases where FUT will provide a greater number.

That said, the difference won’t be substantial so at the end of the day, it’s best to speak to a reputable surgeon about which procedure they feel is right for you.

Most people covet and select FUE because it eliminates the linear scar associated with FUT and is FUE is less invasive.

I also want to say that as long as you’ve selected a reputable surgeon who specializes in FUE, the result you achieve will be comparable to that of FUT and in some cases, even better.  I say that because surgeons have the ability to cherry pick which grafts to extract in the entire donor area whereas with a strip, the surgeon is limited to those that have been excised within the strip.  This is particularly important for re-creating a natural hairline.

Best wishes,

Rahal Hair Transplant

 

Edited April 8, 2022 by Rahal Hair Transplant

[SoSoz]

21 minutes ago, Rahal Hair Transplant said:

I also want to add that most individuals can achieve a large number of follicular units via FUE alone and don’t have to request  both procedures.

Now if you compare the procedures individually because you want to know which of the two procedures as a standalone donor excision technique can provide more eligible hair for transplanting over the long term, I would say it depends.

In general, I would say that they are very comparable and those who choose FUE can obtain just as many grafts as they could if they had underwent FUT.  That said, there will be some cases where FUE will provide a greater number of grafts and in other cases where FUT will provide a greater number.

That said, the difference won’t be substantial so at the end of the day, it’s best to speak to a reputable surgeon about which procedure they feel is right for you.

Most people covet and select FUE because it eliminates the linear scar associated with FUT and is FUE is less invasive.

I also want to say that as long as you’ve selected a reputable surgeon who specializes in FUE, the result you achieve will be comparable to that of FUT and in some cases, even better.  I say that because surgeons have the ability to cherry pick which grafts to extract in the entire donor area whereas with a strip, the surgeon is limited to those that have been excised within the strip.  This is particularly important for re-creating a natural hairline.

Best wishes,

Rahal Hair Transplant

 

What if you are 23/24 with NW3/4 already? Would I benefit from FUT just in case I need more grafts in future from FUE? It was a case for famous rapper Machine Gun Kelly, he got a FUT procedure at 23 and his hair look amazing to this day(he's 31) now.

[Fue3361]

Some very good surgeons say that it is outdated.  Everyone has different opinions.

 

Me personally, I’d never get an FUT at this point. 

[TommyLucchese]

I had a video call with Dr Muresanu from Hattingen last year and heard some things from him that aren't really "gospel" here. They do FUE but are mostly known for large FUT sessions. 

He shook his head quite dispairingly when I said I'd had a 2000 graft FUT procedure on my frontal third. He felt FUT should only be for large cases of 3500 grafts and upwards because it's not worth wasting your laxity on smaller procedures.

He recommended my next crown procedure be FUE because it's only around 1500 grafts.

When I asked if there was a problem doing FUE after FUT at this point way before FUT is exhausted in my donor - he very very confidently shook his head and said there's no problem at all.

It was a very interesting call that definitely threw in some new opinions that I hadn't really heard here over the last decade.

So to your point - what I took from that video call with Hattigen is that it isn't necessarily as simple as FUT v FUE or maximise FUT then do FUE. It would be your age, level of loss, your goals etc. because maybe you do 2000 FUE on the hairline now and then 3500 FUT behind that in 5 years and maybe then 1,500 FUE in the crown in 10 years. By which case you'd still have good laxity for another larger procedure if you need it and still have the donor. 

*please note that it's my interpretation of what Dr Muresanu said, maybe I'm wrong with that final conclusion*

 

 

[baldiee]

The problem with doing FUE first is that you lose the option to do FUT because it messes up the donor harvest area. With FUT, you can do multiple clean strips of harvest. And then perform FUE around it when you've exhausted the strip method. You can also do FUE into the strip scar and conceal it at the end. Ultimately, this is how you can get the highest yield of grafts in the long-run. This method is really good for those with severe hair loss like Norwood 6+. If you are barely thinning in smaller areas, then FUE is probably favorable for you. It just depends on the person, how much hair loss you have, and how many surgeries you are planning to do. 

[Melvin- Admin]

I believe overall, yes you can get more grafts combining both FUT and FUE. However, you can achieve large numbers with FUE+ BHT, this eliminates the strip scar. 
 

BHT+FUT are not mutually exclusive, so you could get FUT+FUE +BHT and get the most grafts. But the scar is something many don’t want, and when you see cases like @Zoomster who has essentially cured hair loss, and doesn’t have to keep his hair long on the sides, it becomes a no-brainer for some, that’s not to say FUT doesn’t have its place for specific cases. 

[NARMAK]

1 hour ago, baldiee said:

The problem with doing FUE first is that you lose the option to do FUT because it messes up the donor harvest area. With FUT, you can do multiple clean strips of harvest. And then perform FUE around it when you've exhausted the strip method. You can also do FUE into the strip scar and conceal it at the end. Ultimately, this is how you can get the highest yield of grafts in the long-run. This method is really good for those with severe hair loss like Norwood 6+. If you are barely thinning in smaller areas, then FUE is probably favorable for you. It just depends on the person, how much hair loss you have, and how many surgeries you are planning to do. 

This is what i think is sometimes ignored. The FUT method allows on the right candidate with enough laxity to have a pencil thin linear scar even after 2 sessions of FUT. Because you are also removing an entire strip of tissue and then sewing it shut means the remaining grafts can overlap too and unlike FUE where you have to more carefully spread out to avoid a look of being over harvested, the FUT usually keeps it in that linear scar zone. 

FUE when you extract like 3-4k grafts and add up all the extraction sites and put them together can probably take up a larger surface area if it was all combined. The spread out nature is usually why people feel its not as visible. 

I also like your point of being able to use grafts to then close up the linear scar. Personally this is where i'd be happy to use chest hair to stuff the linear scar because they usually have sub par growth compared to scalp and beard. If they take, then it helps cover up the scar and you don't have to worry if they don't grow as long as the rest. 

Personally the part that puts me off FUT is the longer recovery time with FUT and the possibility of how the scar could stretch over time and look bigger. 

If somehow in the future Stemson can make clone grafts and scale it up to a reasonable price, i'd think a lot of people would probably stuff their donor back full of hair and dense pack the areas over multiple procedures till they hit native density. 

[SLA]

All very interesting points...

I think top FUE surgeons have figured out how to push the bounds with FUE by harvesting more than once thought possible, yet doing it in a homogeneous way to make it look natural throughout. Classic example is how Dr. Pittella posted a NW 7 case with non-optimal scalp donor in which he harvested more than 50% of donor and the donor area looks fine (see below for reference). Dr. Zarev talks about how he can harvest up to 60% of donor and donor areas look great. I would suspect Zoomster had more than 50% of donor harvested.

As for me- I consulted in person with Dr. Bisanga who has mastered and performs both techniques. I am virtually an NW6, fine (yet curly) hair, non-optimal donor 65 grafts per sq./cm and he advised FUE + BHT- 2 surgeries ~5k-5.5k scalp and 2-2.5k beard). He said, if you do FUT, it can lead to miniaturization below the strip scar leading those hair non-harvestable; he said he doesn't have the ability to determine if that would happen. His opinion was that many surgeons who push FUT haven't mastered FUE.

He says he performs FUT is a patient wants as much as they can in one go and wouldn't mind linear scar.

 

 

[Gramatik]

There’s always high chance of risk that you will get a big scar in donor with FUT and it is more serious and severe surgery than FUE. Also it takes many months for the strip to heal and you will feel pain in donor for long time too…

If high Norwoods can maximise the donor using Combining FUE and BHT, there’s no any reason for someone to choose FUT and get a big scar on his donor. 
 

[anotherbaldguy]

11 hours ago, Rahal Hair Transplant said:

 As a result, this makes them fragile and not the best for transplanting in subsequent procedures. This is fine if you are sticking with the FUE method. But if you move onto FUT, an entire strip of tissue is removed and many of the grafts within the strip contain damaged tissue from the FUE…thus, making them ineligible for transplanting.

No, an experienced tech team able to dissect a strip properly can handle that. Unfortunately it takes a very long time to train such a team and there are fewer and fewer higher quality clinics existing.

9 hours ago, TommyLucchese said:

He shook his head quite dispairingly when I said I'd had a 2000 graft FUT procedure on my frontal third. He felt FUT should only be for large cases of 3500 grafts and upwards because it's not worth wasting your laxity on smaller procedures.

So to your point - what I took from that video call with Hattigen is that it isn't necessarily as simple as FUT v FUE or maximise FUT then do FUE. It would be your age, level of loss, your goals etc. because maybe you do 2000 FUE on the hairline now and then 3500 FUT behind that in 5 years and maybe then 1,500 FUE in the crown in 10 years. By which case you'd still have good laxity for another larger procedure if you need it and still have the donor. 

If you are going to do FUT you should commit to the scar and go for as many grafts as possible yes. I made the same mistake by only doing 2000 grafts for my first FUT when I clearly needed more, but the surgeon I went to argued that the yield was optimal at 2000 grafts. Realistically though do H&W, Eugenix or Hattingen have yield issues when they are routinely performing sessions over 2000 grafts? Of course not, so ultimately i think it's because certain clinics are simply unable to handle higher numbers.

Hattingen is one of the few honest/ethical clinics I consulted with. 

7 hours ago, baldiee said:

The problem with doing FUE first is that you lose the option to do FUT because it messes up the donor harvest area.  

Depends on the amount of grafts taken by FUE. Around 3000 and it's still fine. I just had a strip taken after some bad FUE and the FUT scar currently appears smaller than the FUE scars. But of course this is all patient dependent; you should only consider doing a strip after FUE if your laxity is above average, your remaining donor density is sufficient, you need the grafts, and the patient is fine wearing their hair longer. And ofc the clinic needs to be good enough/ experienced in removing a strip from scar tissue.

5 hours ago, NARMAK said:

The FUT method allows on the right candidate with enough laxity to have a pencil thin linear scar even after 2 sessions of FUT. 

Physiology matters, but ultimately it's surgeon's skill. That's why you'll notice certain surgeons seem to consistently achieve better FUT scars than others - the exact same as FUE. I've seen a documented case here on the forum where the FUT scar is pencil thin scar after 5 surgeries. 

4 hours ago, SLA said:

(Bisanga's) opinion was that many surgeons who push FUT haven't mastered FUE.

This can be true, but the same can be said of FUE surgeons who haven't mastered FUT and dont have the larger tech teams available to be able to support it. Most patients simply don't want the linear scar so the market is simply responding to this. Ideally you'd want a clinic capable of both and to (objectively) be able to take your individual donor characteristics into account. 

1 hour ago, Gramatik said:

There’s always high chance of risk that you will get a big scar in donor with FUT and it is more serious and severe surgery than FUE. Also it takes many months for the strip to heal and you will feel pain in donor for long time too… 
 

No. FUE causes more scarring than FUT in terms of surface area. One bad FUE session and you can deplete your donor globally meaning you are out of options, whereas one bad FUT session and the scar is still localised. With a bad FUT scar you might have the option to pursue another FUT or conduct a scar revision, or failing that place grafts in the scar while still having the majority of the donor left completely intact. Bad FUE scarring only has the option of BHT or SMP, overall meaning you're looking at obtaining far less graft numbers with FUE alone. 

FUT is the more serious surgery, but you'll only feel pain in the donor region if the FUT surgeon is incompetent and creates nerve damage or does something else medically negligent. Nerve damage happens with FUE clinics as well

 

For my last surgery I had multiple (elite) clinics try and dissuade me from doing another strip due to my FUE scarring, and if i had listened to them i would only be able to get 2k more out of my donor. After a lot of research and a lot of consults I ultimately ignored their advice and pursued another FUT with an elite clinic ... and due to my extreme laxity I'm now able to get another 7k out of my donor. That's a 5k difference in grafts simply due to pursuing one extraction over the other. Every case is different, so ultimately this stuff all comes down to a patient's individual donor characteristics, what a patient is willing to commit to, and what a specific clinic can achieve. So you really can't be too dogmatic about this. 

[BurnieBurns]

1 hour ago, anotherbaldguy said:

No, an experienced tech team able to dissect a strip properly can handle that. Unfortunately it takes a very long time to train such a team and there are fewer and fewer higher quality clinics existing.

If you are going to do FUT you should commit to the scar and go for as many grafts as possible yes. I made the same mistake by only doing 2000 grafts for my first FUT when I clearly needed more, but the surgeon I went to argued that the yield was optimal at 2000 grafts. Realistically though do H&W, Eugenix or Hattingen have yield issues when they are routinely performing sessions over 2000 grafts? Of course not, so ultimately i think it's because certain clinics are simply unable to handle higher numbers.

Hattingen is one of the few honest/ethical clinics I consulted with. 

Depends on the amount of grafts taken by FUE. Around 3000 and it's still fine. I just had a strip taken after some bad FUE and the FUT scar currently appears smaller than the FUE scars. But of course this is all patient dependent; you should only consider doing a strip after FUE if your laxity is above average, your remaining donor density is sufficient, you need the grafts, and the patient is fine wearing their hair longer. And ofc the clinic needs to be good enough/ experienced in removing a strip from scar tissue.

Physiology matters, but ultimately it's surgeon's skill. That's why you'll notice certain surgeons seem to consistently achieve better FUT scars than others - the exact same as FUE. I've seen a documented case here on the forum where the FUT scar is pencil thin scar after 5 surgeries. 

This can be true, but the same can be said of FUE surgeons who haven't mastered FUT and dont have the larger tech teams available to be able to support it. Most patients simply don't want the linear scar so the market is simply responding to this. Ideally you'd want a clinic capable of both and to (objectively) be able to take your individual donor characteristics into account. 

No. FUE causes more scarring than FUT in terms of surface area. One bad FUE session and you can deplete your donor globally meaning you are out of options, whereas one bad FUT session and the scar is still localised. With a bad FUT scar you might have the option to pursue another FUT or conduct a scar revision, or failing that place grafts in the scar while still having the majority of the donor left completely intact. Bad FUE scarring only has the option of BHT or SMP, overall meaning you're looking at obtaining far less graft numbers with FUE alone. 

FUT is the more serious surgery, but you'll only feel pain in the donor region if the FUT surgeon is incompetent and creates nerve damage or does something else medically negligent. Nerve damage happens with FUE clinics as well

 

For my last surgery I had multiple (elite) clinics try and dissuade me from doing another strip due to my FUE scarring, and if i had listened to them i would only be able to get 2k more out of my donor. After a lot of research and a lot of consults I ultimately ignored their advice and pursued another FUT with an elite clinic ... and due to my extreme laxity I'm now able to get another 7k out of my donor. That's a 5k difference in grafts simply due to pursuing one extraction over the other. Every case is different, so ultimately this stuff all comes down to a patient's individual donor characteristics, what a patient is willing to commit to, and what a specific clinic can achieve. So you really can't be too dogmatic about this. 

Using a good surgeon is paramount. I got nerve damage from a bad FUE doctor

[Gramatik]

14 hours ago, anotherbaldguy said:

No, an experienced tech team able to dissect a strip properly can handle that. Unfortunately it takes a very long time to train such a team and there are fewer and fewer higher quality clinics existing.

If you are going to do FUT you should commit to the scar and go for as many grafts as possible yes. I made the same mistake by only doing 2000 grafts for my first FUT when I clearly needed more, but the surgeon I went to argued that the yield was optimal at 2000 grafts. Realistically though do H&W, Eugenix or Hattingen have yield issues when they are routinely performing sessions over 2000 grafts? Of course not, so ultimately i think it's because certain clinics are simply unable to handle higher numbers.

Hattingen is one of the few honest/ethical clinics I consulted with. 

Depends on the amount of grafts taken by FUE. Around 3000 and it's still fine. I just had a strip taken after some bad FUE and the FUT scar currently appears smaller than the FUE scars. But of course this is all patient dependent; you should only consider doing a strip after FUE if your laxity is above average, your remaining donor density is sufficient, you need the grafts, and the patient is fine wearing their hair longer. And ofc the clinic needs to be good enough/ experienced in removing a strip from scar tissue.

Physiology matters, but ultimately it's surgeon's skill. That's why you'll notice certain surgeons seem to consistently achieve better FUT scars than others - the exact same as FUE. I've seen a documented case here on the forum where the FUT scar is pencil thin scar after 5 surgeries. 

This can be true, but the same can be said of FUE surgeons who haven't mastered FUT and dont have the larger tech teams available to be able to support it. Most patients simply don't want the linear scar so the market is simply responding to this. Ideally you'd want a clinic capable of both and to (objectively) be able to take your individual donor characteristics into account. 

No. FUE causes more scarring than FUT in terms of surface area. One bad FUE session and you can deplete your donor globally meaning you are out of options, whereas one bad FUT session and the scar is still localised. With a bad FUT scar you might have the option to pursue another FUT or conduct a scar revision, or failing that place grafts in the scar while still having the majority of the donor left completely intact. Bad FUE scarring only has the option of BHT or SMP, overall meaning you're looking at obtaining far less graft numbers with FUE alone. 

FUT is the more serious surgery, but you'll only feel pain in the donor region if the FUT surgeon is incompetent and creates nerve damage or does something else medically negligent. Nerve damage happens with FUE clinics as well

 

For my last surgery I had multiple (elite) clinics try and dissuade me from doing another strip due to my FUE scarring, and if i had listened to them i would only be able to get 2k more out of my donor. After a lot of research and a lot of consults I ultimately ignored their advice and pursued another FUT with an elite clinic ... and due to my extreme laxity I'm now able to get another 7k out of my donor. That's a 5k difference in grafts simply due to pursuing one extraction over the other. Every case is different, so ultimately this stuff all comes down to a patient's individual donor characteristics, what a patient is willing to commit to, and what a specific clinic can achieve. So you really can't be too dogmatic about this. 

Personallly I would prefer to shave my head rather than choosing FUT. There’s a high possibility that your Fut scar will stretch and become bigger depending on the candidate. Also by selecting fut you would not be able to harvest many grafts by FUE after cause as the donor would become less dense then the scar would be more visible.  Also The grafts up and down from the scar may miniturize and become useless. 
 

I have also heard fut patients telling that they suffer from chronic pains in the linear scar of fut… most clinics tend to stop doing fut, and they have found different ways to maximise donor harvesting 50-60% of it and homogenising donor so it would look fine. Also I strongly believe bht and FUE is much better option than choosing old fashioned fut method.

Clinics like eugenix can harvest many grafts from beard so there’s no any reading to choose FUT. 

Edited April 9, 2022 by Gramatik

[Curious25]

1 hour ago, Gramatik said:

Personallly I would prefer to shave my head rather than choosing FUT. There’s a high possibility that your Fut scar will stretch and become bigger depending on the candidate. Also by selecting fut you would not be able to harvest many grafts by FUE after cause as the donor would become less dense then the scar would be more visible.  Also The grafts up and down from the scar may miniturize and become useless. 
 

I have also heard fut patients telling that they suffer from chronic pains in the linear scar of fut… most clinics tend to stop doing fut, and they have found different ways to maximise donor harvesting 50-60% of it and homogenising donor so it would look fine. Also I strongly believe bht and FUE is much better option than choosing old fashioned fut method.

Clinics like eugenix can harvest many grafts from beard so there’s no any reading to choose FUT. 

With respect, your posts are just coming across as though you are driving an FUE propaganda train.
 

You’re categorising worst case scenarios of FUT as though they are guaranteed to occur, which is simply not the case. 
 

At the end of the day, like pretty much everything in the world of hair restoration - it always come down to the individual patient, and surgical plans should always be assessed on a case by case basis. 
 

Then, after establishing this, can a patient weigh up the pro’s and con’s, and choose a decision which is subjective to them - for example patients who are so adamant they don’t want a linear scar, may be able to rationalise with themselves that they are willing to lose out on a few K extra grafts in order to avoid the scar, and have the option to wear their hair shorter on the back and sides. That’s their decision. 
 

 

[Melvin- Admin]

Great discussion guys, let me tag @Dr. Felipe Pittella @DrTBarghouthi let’s see what they think.

[DrTBarghouthi]

Great discussion indeed. Thanks for tagging @Melvin- Moderator

The reality is donor hair to this day is limited, so whatever maximizes the potential of the donor area is valid. To maximize donor availability, one can certainly go for multiple strips and the FUE or even a combination in one go. One can also seek “non scalp” donor for such purposes too. The main thing is to always leave patients with future options and the potential to do more if they need it. A good strip will usually yield in the region of 2000 grafts on average. Now the problem is that most young patients prefer nowadays not to get the scar so early in life. However, if they are a high risk of developing NW6+ hair loss, it is important to leave some sort of security in their donor area. In such patients, we can start with FUE but leave a virgin strip of un-extracted area. This strip would not have any scars or punched out areas and “may” become an invaluable saving in the future, should they elect for a future strip in the future. Their desire to avoid strip scars now may well change in the future and they can settle for growing their hair longer to hide the strip scar. I do it on quite a number of people whom might have a limited donor and a potential for advanced loss/ or are currently advanced. I don’t feel FUT is outdated, just sometimes we have to work the other way around to what is conventionally done. 

[SLA]

Thanks for sharing @DrTBarghouthi. Curious to hear the take from @Dr. Felipe Pittellaas I know opinions vary large and wide about maximizing lifetime donor.

[Dr. Felipe Pittella]

Very rich topic. Thanks for tagging @SLA and @Melvin- Moderator I appreciate it.

First and foremost we should keep in mind that the main objective of hair transplantation is naturalness. If a surgeon is capable of reaching a natural result, i.e., with density, enough amount of hair, natural hairline (according to patients anatomical limits), uniformity and etc, it doesn't matter whether he is doing FUT or FUE. The question is: "is it possible to reach a natural result with a linear scar in the donor area?". In the hands of a good surgeon "yes" it is possible. A well performed FUT with trichophitic suture will leave an almost undetectable scar even with a short hair stile. 

On the other hand a poorly performed FUE will ruin the donor and may leave plenty of large white dots.

Notice that I'm not advocating in favor of FUT. Despite the fact that my early masters are 2 FUT expertises***: Dr Marcelo Pitchon (2021 ISHRS golden follicle award), and Dr Roberto Trivellini (2021 ISHRS platinum follicle award), I myself won't perform a FUT in none of my patients. 

In regards of amount of follicles, I disagree when they say that it is possible to harvest a higher amount of grafts with FUT+FUE than only with FUE. But of course this amount will largely vary from surgeon to surgeon. In my opinion the current trend is scoring more and more FUE grafts in only one sitting. The number are already high. And I bet they'll rise. 

 

***Dr Pitchon created the FUT "preview long-hair technique" (in which the follicles are transplanted without trimming. A masterpiece. Probably the future on HT in FUE). And Dr Trivellini lately changed to FUE and developed the MAMBA Device. 

 

 

[SLA]

16 hours ago, Dr. Felipe Pittella said:

In regards of amount of follicles, I disagree when they say that it is possible to harvest a higher amount of grafts with FUT+FUE than only with FUE.

Thanks @Dr. Felipe Pittella- I appreciate you answering this question as I know it sparks heated debate and by no means do I want to start WWIII :)!

Just to be clear, with the statement I quoted from you, that this is in regards to what one can harvest in a lifetime?

So, if I am understanding you correctly, you feel that in the lifetime of a patient, you can harvest the same amount of grafts whether you are performing FUT/FUE over the course of multiple surgeries vs. FUE alone over the course of multiple surgeries.

Is this correct?

Thanks!

[Curious25]

16 hours ago, Dr. Felipe Pittella said:

 I myself won't perform a FUT in none of my patients. 

In regards of amount of follicles, I disagree when they say that it is possible to harvest a higher amount of grafts with FUT+FUE than only with FUE.

 

Hi Dr, 

Would you be able to further elaborate as to why, for each of these two points ? Very interested to head your take on this, 

Thanks