FUT or FUE?

[Trobs4]

Hello all, longtime lurker. I’ve decided to get a HT. Here’s my current situation: and I’m an NW4 clearly headed to NW5 and 6. I haven’t been able to take finasteride because of recommendations from doctors for fertility issues, however if my wife isn’t pregnant by January we will do IVF (we have embryos). I’ll start taking finasteride again as soon as that process begins. 
 

I’m trying to determine if FUT or FUE is the better option. I could do Dr Wong in August 2024 or Dr Espinosa Custodio in Feb 2024 in Mexico City. I’m currently scheduled with Dr Custodio.

Wong would do FUT and could do ~5000 grafts. It would cost about $24,000. 
 

Custodio would do ~2500-3000 FUE for $7500-9000. I’d almost certainly have to go back a year later and get more grafts to cover the crown. 
 

Is it worth waiting and doing FUT and getting it done later, or would you recommend doing FUE in two sessions and save a little cash? 
 

I could also do Dr Gur (3000-3500 grafts FUE) mid January. The VIP plan is €1.50 per graft so €5,250 on the high end. This would also require a second procedure to cover the crown. 
 

Lastly I could do Dr Laorwong in Thailand late January-early February. 80 baht per graft ($2.40/graft) and approximately $8,400. This also includes some extras like PRP and other treatments over the course of the next five days. 

additional costs like airfare and hotel (7 days)-

Mexico City - $1800

Vancouver - $2400  

Turkey - $6000 (business class unless I can book with miles)

 Thailand - $6000 (business class unless booked with miles)

I can take as much time off as necessary and work from the road. If you were in my shoes, what would you do? The scar and recovery aspect of FUT doesn’t sound fun, but Dr Wong is highly regarded. These others appear to be well regarded as well. Curious for thoughts on FUT vs FUE timeline. 
 

Ant other helpful thoughts will be greatly appreciated. 
 

attaching some photos of my current situation. Wet hair combed forward. 

[jjalay]

From the doctors you are mentioning they are all good options but i would go with dr. Wong. In my opinion he does the best work when it comes to the crown making every graft counting. You are almost a NW-5 so you need at least 5000 grafts to do the whole area with the crown. FUT gives you this posibility in one go and leaves you enough grafts if you ever need another surgery per fue in the future. Wong does the best work per fut in my opinion too with very small scars.

[mrmajified]

I'd say do it all in one go. I'm 3.5 months post surgery and the waiting game is horrible. I couldn't imagine having to do that twice.

[Trobs4]

Thanks for your input. The biggest issue for me is Wong doesn’t have availability until August 2024. Would love to get in earlier. But I suppose if I can get it all done in one go (or at least something that could last me several years), it’s perhaps overall the better option. The cost is obviously much higher but hopefully that means the results will be too.

[hongkongfue]

I've had both with Dr. Wong, FUT then 18 years later the FUE.  I did like the healing quicker of the FUE over the FUT and not having to deal with the staples, but since you need a lot of graphs I would vote to wait for Dr. Wong and get the FUT and get as many graphs as you can.  You have a lot of real estate to cover also so you are going to be closer to be satisfied with having more the first round then less.   Sometimes I feel like on the forum people don't really how fast graphs get eaten up and then they are disappointed, so best to have realistic expectations regardless of what the doctors may tell you.  But if you want to keep your hair really short no way around the FUT scar if that is going to factor in for you.  I think which either way you go, you may end up wanting a second pass also since even 5k goes quick depending on how you want to use them, for me I was going more for coverage than density.  I've shared both my FUT and recent FUE pictures in the review section and lots of other recent Dr. Wong patients as well.  I can tell you that also not staying on finasteride the whole time definitely set me back some.  I took it the first several years, then faded off when wanting to have kids and never went back until I did my last consult with Dr. Wong for this surgery and plan to stay on it consistently going forward. Best of luck on everything!

[Turkhair]

Not a fan of FUT so that won’t be an option for me. Rest of the doctors you mentioned are all pretty good and can’t wrong with either 

[asterix0]

I would go with Dr Laorwong from your list, he has had some good results here recently. 

[GeneralNorwood]

The thing is that you are not Nw4. But i undederstand your thinking, because i was downgrading myself too before my HT. 

 

This is your hairloss pattern (red area). This is Norwood 6 pattern : 

 

And you can say "but i have hair there". Yeah, but they are miniaturised, thin, light colored. This hair have limited lenght. Compare them to healthy hair on your sides, it is like night and day.

 

You need 8000 + grafts for the whole area and it will start too look good. Of course you could skip the crown and leave it bald, it would reduce amount of grafts needed. So the questions is what is your plan. If you want full coverage, FUT is the best option. 

 

Now, if could turn back time, i would do FUT for my first procedure. It is way better for higher Norwoods. You can extract 100% grafts from area that has  very strong DHT resistance, so it is best longterm option. And you will still have thousands of grafts in the bank for FUE procedure. 

 

Listen, before my procedure i thought that im Norwood 3V, but in reality i have Norwood 6 diffuse hairloss pattern. I had 2500 implanted on the front, 720 on the temple points and only 350 on the crown. Now contrast between front and back is huge, because on the front i have new, strong, healthy hair and behind them i have miniaturised hair. You can read my journey and learn from my mistakes. 

BTW, because of unnatural look, i want to do next HT. Luckily i have some donor left and although it will be second procedure, i want to do FUT anyway. Harvest won't be so rich, but i think it will expand my donor possibilities anyway. 

 

If you to do 2500-3000 FUE for frontal third only, expect result like this: 

 

Do you like the outcome? I don't

Edited September 10, 2023 by GeneralNorwood

[Trobs4]

Thanks all for the input. My comment “NW4 clearly headed to NW5 and 6” was based on a doctors analysis, but I certainly agree that I will need a lot of grafts (8000 would probably be ideal) to get good coverage. I will probably decide to stick with Dr Wong for next august, and maybe sooner if they have a cancellation. 
 

My biggest issue I with the Wong FUT is the waiting… psychologically I’m ready to do this asap, so having to wait an extra 6 months will be tough, but I’ve waited this long already so I guess I can wait a little longer. 
 

On the plus side, hopefully I’ll be able to start taking fin/dut early in the year to help solidify some of the existing hairs. 
 

Are there other doctors worth considering for FUT with 4000-5000 grafts that could do as good a job as Dr Wong? Maybe I should just be patient. 

[GeneralNorwood]

1 minute ago, Trobs4 said:

 

Are there other doctors worth considering for FUT with 4000-5000 grafts that could do as good a job as Dr Wong? Maybe I should just be patient. 

Muresanu in Switzerland (Hattingen clinic). 

You can check results on this forum and there are more on alopezia.de

 

 

[Trobs4]

Just now, GeneralNorwood said:

Muresanu in Switzerland (Hattingen clinic). 

You can check results on this forum and there are more on alopezia.de

 

 

Many thanks. I will look into this. 

[BurnieBurns]

You are most definitely a NW6 , NOT a NW4. 3k fue grafts will simply not give you the density you'll probably be satisfied with. 

With your advanced pattern, my view is:  Do you care about having a linear scar? If not, FUT is a no brainer.

Going FUE only is possible but you'd no doubt have to resort to beard grafts unless all you desire is a 'thinning' look. You'd also in this case want to consult with FUE clinics that specialise in high-norwoods.

Based on those options I'd hold out for Dr Wong (I had a 5.8k FUT with him last year and have nothing but praise). He also often does FUE cases putting grafts into linear scars disguising it further.

Hattingen would also be worth consulting with. I've heard them say they take a lot of inspiration from Dr Wong's approach.

[ScottishGuy21]

As above both options for FUT about as good as any in the world. 
 

Im more familiar with Hattingens work being European based, both Dr’s Sever and Laura Muresanu are fantastic in what they do and very open about their processes. I’m sure Melvin did an interview not too long ago with them?

[shiba1985]

13 hours ago, GeneralNorwood said:

The thing is that you are not Nw4. But i undederstand your thinking, because i was downgrading myself too before my HT. 

 

This is your hairloss pattern (red area). This is Norwood 6 pattern : 

 

And you can say "but i have hair there". Yeah, but they are miniaturised, thin, light colored. This hair have limited lenght. Compare them to healthy hair on your sides, it is like night and day.

 

You need 8000 + grafts for the whole area and it will start too look good. Of course you could skip the crown and leave it bald, it would reduce amount of grafts needed. So the questions is what is your plan. If you want full coverage, FUT is the best option. 

 

Now, if could turn back time, i would do FUT for my first procedure. It is way better for higher Norwoods. You can extract 100% grafts from area that has  very strong DHT resistance, so it is best longterm option. And you will still have thousands of grafts in the bank for FUE procedure. 

 

Listen, before my procedure i thought that im Norwood 3V, but in reality i have Norwood 6 diffuse hairloss pattern. I had 2500 implanted on the front, 720 on the temple points and only 350 on the crown. Now contrast between front and back is huge, because on the front i have new, strong, healthy hair and behind them i have miniaturised hair. You can read my journey and learn from my mistakes. 

BTW, because of unnatural look, i want to do next HT. Luckily i have some donor left and although it will be second procedure, i want to do FUT anyway. Harvest won't be so rich, but i think it will expand my donor possibilities anyway. 

 

If you to do 2500-3000 FUE for frontal third only, expect result like this: 

 

Do you like the outcome? I don't

I remember commenting on your thread 

“ This is a ball-sy restoration for someone with your level of hairloss and your balding pattern. I would have recommended something much more conservative to keep it looking natural. From the side view you can see there is a gap between where you existing hair stops and where the hair transplant begins. “

 

I wish more clinics would be real and plan with the long term cosmetic appearance of the patient in mind, instead of just looking at short term gratification.

 

[Turkhair]

13 hours ago, GeneralNorwood said:

 

Listen, before my procedure i thought that im Norwood 3V, but in reality i have Norwood 6 diffuse hairloss pattern. I had 2500 implanted on the front, 720 on the temple points and only 350 on the crown. Now contrast between front and back is huge, because on the front i have new, strong, healthy hair and behind them i have miniaturised hair. You can read my journey and learn from my mistakes. 

 

720 is a massive amount of grafts to be wasted on temple points. If they were used in midscalp, you would’ve been ecstatic with the outcome. 
 

In my opinion temple points should only be done once everything else is recreated to perfection. They don’t matter at all

Edited September 10, 2023 by Turkhair

[asterix0]

1 hour ago, Turkhair said:

720 is a massive amount of grafts to be wasted on temple points. If they were used in midscalp, you would’ve been ecstatic with the outcome. 
 

In my opinion temple points should only be done once everything else is recreated to perfection. They don’t matter at all

And they are very, very hard to get a natural look. 

[UKLad81]

@Trobs4 If you are looking at FUT you should also consider Hattingen. I would say they are  just as good as Dr Wong. 

@ScottishGuy21 & @GeneralNorwood are you both Hattingen patients? 

[Trobs4]

Thanks to all who recommended Hattingen, I’ve looked into this clinic a bit more and the results appear to be fantastic across the board, especially for higher NW cases like mine. 
 

I emailed Hattingen about my situation and hope to hear back this week to initiate further discussion. Waiting until August 2024 for Dr Wong would be challenging, so I’m very hopeful that Hattingen has availability towards the beginning of the new year. I’ll follow up with their thoughts and ultimately what my decision is. 

[UKLad81]

5 minutes ago, Trobs4 said:

Thanks to all who recommended Hattingen, I’ve looked into this clinic a bit more and the results appear to be fantastic across the board, especially for higher NW cases like mine. 
 

I emailed Hattingen about my situation and hope to hear back this week to initiate further discussion. Waiting until August 2024 for Dr Wong would be challenging, so I’m very hopeful that Hattingen has availability towards the beginning of the new year. I’ll follow up with their thoughts and ultimately what my decision is. 

I’m in discussions with them and have been in reasonable dialog with them for the last month. From my most recent interaction with the clinic i can tell you they seem to be solidly booked this side of Xmas but have openings starting mid Jan. I initially had trouble uploading my photos on their website so emailed the general email address and Dr Sever emailed back within a day or so asking for pictures. I’ve had two skype consults with him. He’s a very good guy and tells you how it is. Very re-assuring! 

[GeneralNorwood]

7 hours ago, shiba1985 said:

I remember commenting on your thread 

“ This is a ball-sy restoration for someone with your level of hairloss and your balding pattern. I would have recommended something much more conservative to keep it looking natural. From the side view you can see there is a gap between where you existing hair stops and where the hair transplant begins. “

 

 

 

Yeah, i remember that comment, that was on point. 

7 hours ago, shiba1985 said:

 

I wish more clinics would be real and plan with the long term cosmetic appearance of the patient in mind, instead of just looking at short term gratification.

 

I don't think that we can talk about short term gratification regarding my result. The planning was just bad and crazy 😅

 

7 hours ago, Turkhair said:

720 is a massive amount of grafts to be wasted on temple points. If they were used in midscalp, you would’ve been ecstatic with the outcome. 
 

In my opinion temple points should only be done once everything else is recreated to perfection. They don’t matter at all

720 but some of grafts were splits, so it was in fact less. And they look for thinner hair for temple points, behind ear or at the nape of the neck, so this hair wouldn't make such great job on midscalp like normal hair. 

[mrmajified]

2 hours ago, Trobs4 said:

Thanks to all who recommended Hattingen, I’ve looked into this clinic a bit more and the results appear to be fantastic across the board, especially for higher NW cases like mine. 
 

I emailed Hattingen about my situation and hope to hear back this week to initiate further discussion. Waiting until August 2024 for Dr Wong would be challenging, so I’m very hopeful that Hattingen has availability towards the beginning of the new year. I’ll follow up with their thoughts and ultimately what my decision is. 

My surgery with Dr. Wong was scheduled for November of this year (1 year after consult). I sent an email in January asking if they had any cancellations and was lucky to get it rescheduled for May. Worth checking in next month if you haven't booked anything with another surgeon yet.

[Rawkerboi]

Go with Dr.Wong, coz he has world class experience in FUT and he is perfect to do mega session like yours.

I am pretty sure there will be some cancellation and you will get your HT sooner.

[Trobs4]

 @UKLad81 thank you for the insight. Sometime around mid-January would actually be ideal for me. Hopefully I can engage in a discussion with them this week. 
 

@mrmajified I just scanned your thread, thanks for sharing all that. Looks like it’s coming along very nicely. I will check in with them about cancellations. 
 

I’m sure a lot of people here will understand my feelings that now that I’ve made up my mind to do this, waiting longer sounds like agony. It seems like I’d be in good hands with either of Wong or Hattingen. Thanks again. 

[Judelaw]

I worry that you’re rushing into such a life-changing commitment without even settling on medication yet. 

What else are you currently using, and are you 100% committed to continuous daily Finasteride starting in January?
 

 

[rs525]

Depends on where you live, but I wouldn't do FUT if possible. Don't want to deal with a permanent scar and all that.