Is FUT for graft maxing outdated advise

[anotherbaldguy]

If the question is "is FUT for graft maxing outdated" then the answer is no. You can still get more grafts overall by starting with FUT (and then adding FUE + even BHT). H&W Doug did an interview where he suggested you can get at least 2k more grafts starting with FUT, which seems to be superficially confirmed by comparing the results for their FUT vs FUE on their homepage. Whether this extra 2k grafts for the average patient is ultimately worth it however is largely debatable and obviously a matter of preference. 

If the question is "is FUE + BHT enough to cover all my needs" then the tentative answer is yes. There are now more than a few clinics that can handle this and the technology has improved so much that a higher NW may now choose to pursue this path instead.

I think it's possible then to potentially reframe this thread as a FUT vs BHT debate, looking at which is the better method to meet the needs and goals of higher NWs. Each extraction method of course comes with a compromise; with FUT you get the linear scar, while BHT isn't always a good match and has different growth cycles. And of course each patient is different and is a better candidate for one or the other. Perhaps the focus shouldn't be on a which approach is ultimately better then, but rather what is in a patient's best interests.

One caveat worth mentioning however is that the donor is known to thin over time - with an even further percentage of patients experience thinning of the transplanted hair as well - which would be a major argument against FUE and not taking your donor to its limits with a homogenous depletion. For younger patients this is particularly troubling as it would not only leave them with an unnatural transplanted appearance on top but few options to fix it in the future.  There was a member who posted just today highlighting this issue

 

I am hesitant to use my own case as an example, but i did mention previously that due to my scalp laxity my donor capacity is closer to that of 12.5k with FUT as opposed to 7.5k with FUE alone. I have little beard hair and it's not a good match. I'm a NW5 and have undergone both FUT and FUE.

The strip we took for my last surgery was 21.5cm x4cm (not even the usual 30cm strip that takes the strip well passed the ears), and I still have more FUT surgeries available to me after this. 

You can see the scarring I have incurred from previous surgeries; the FUT scar at the bottom of the shaved area is under 1mm, while the FUE extractions above are all larger in size. The FUE scarring was deemed bad enough that I was cautioned against any major or further FUE harvests by more than a few clinics. However as I still had the option of FUT available I found I was not only able to get far more grafts by pursuing a strip, but in doing so it has already significantly improved the overall look of my donor by removing a vast majority of these FUE scars. I am clearly an outlier, but nobody could possibly argue that I am not the ideal FUT candidate.

Based on personal experience then I can only suggest that any clinic that disregards or rejects FUT outright either doesn't have the expertise to pursue it, or fails to take into account a patient's individual donor characteristics. So I said much earlier each case is different and should be approached accordingly ... it's best to leave dogmatism at the door. 

[olmert]

 

@1978matt, where are you getting this 80% retention rate for FUE and 90% retention rate for FUT? Doesn't @Melvin- Moderator bring a video from Hasson saying his FUE has a higher retention rate than with FUT? 

Is a supposed higher retention rate with FUT the entire reason some believe you can get more with a combo FUT/FUE than with only FUE? 

[1978matt]

14 hours ago, olmert said:

 

@1978matt, where are you getting this 80% retention rate for FUE and 90% retention rate for FUT? Doesn't @Melvin- Moderator bring a video from Hasson saying his FUE has a higher retention rate than with FUT? 

Is a supposed higher retention rate with FUT the entire reason some believe you can get more with a combo FUT/FUE than with only FUE? 

I saw a bit of that video and I think he is talking about growth.  I'm making an assumption about transsection / failed extractions, and also for increasingly difficult extraction after a few HTs.

If you want you can just assume 100% for both.

[NARMAK]

My personal take on it is that 2k extra grafts via starting with FUT is a significant number of extra grafts. That potentially if they're grafts that can be split with say 500 of them being double grafts or greater could mean when split, you end up with an extra 1000 grafts to use. 

That's the beauty of FUT too imo, that you can get two strips potentially on the right candidate and use the same linear single scar and then switch to FUE and imo, the total size of a linear scar is smaller than the total size of what FUE scars will cumulatively add up to. 

That said, i would love to see a damn landmark change in the hair transplant industry finally happen where we can get those Stemson grafts they think they'll be able to deliver to give us an unlimited well of grafts. It will essentially eliminate the issue of donor supply and best methods or using BHT. 

You can also potentially go back and say have them maybe actually do a hair transplant to repair the extraction zones in the donor areas from previous surgeries and give you back the thickness you had or help potentially those with retrograde alopecia issues too. 

[Melvin- Admin]

I see the debate has moved on from is FUT better than FUE. Now, its “does FUT first, maximize grafts.” I think if you have a loose scalp, unequivocally, yes. But, if you don’t have a loose scalp and you’re only able to get maybe one strip with 3,000 grafts. It’s probably better to go FUE. 

The reason is that after a strip, you can’t harvest as much grafts, because you need to keep enough density to disguise the scar. Dr. Hasson’s point of getting more hair with FUE is also worth noting. Strips on average have about 1.8-2.0 hairs per graft, FUE has around 2.0-2.5 hairs per graft. In the end, it depends on the individual. No cookie cutter black and white answer. 

[anotherbaldguy]

1 minute ago, NARMAK said:

My personal take on it is that 2k extra grafts via starting with FUT is a significant number of extra grafts.

According to Shapiro interview that Melvin did its an extra 3k grafts. My bad for getting the numbers wrong. 

2 minutes ago, Melvin- Moderator said:

In the end, it depends on the individual. No cookie cutter black and white answer. 

100%

[Curious25]

This thread just needs to be summarised on 

‘it depends on the individual, and can only be determined on a case by case basis’

(like what I said last week you bored apes) 

 

and closed. 
 

I’m all for debate, but the sooner people start realising there’s no one size fits all for most components of hair loss and hair restoration, the better for their own research and subsequent journeys. 

 

[Melvin- Admin]

On 4/15/2022 at 10:25 AM, Curious25 said:

This thread just needs to be summarised on 

‘it depends on the individual, and can only be determined on a case by case basis’

(like what I said last week you bored apes) 

 

and closed. 
 

I’m all for debate, but the sooner people start realising there’s no one size fits all for most components of hair loss and hair restoration, the better for their own research and subsequent journeys. 

 

Here’s another reported post, why do you feel the need to insult the community by calling them ‘bored apes’ I’m lenient, but this getting to be too much. 

[Curious25]

1 hour ago, Melvin- Moderator said:

Here’s another reported post, why do you feel the need to insult the community by calling them ‘bored apes’ I’m lenient, but this getting to be too much. 

It’s an NFT.