FUE-FUT Combo. Am I a good candidate?

[tacale]

Hi All, 

I did a FUE operation with Dr Saifi 2 years ago for 2400 grafts. I was a NW5 if not 6 so I knew going in the 2400 wouldn't solve everything and I would need more operations in the future.

Interestingly Dr Saifi told me he would leave a strip on the back of my head in case I ever wanted to do FUT in the future. 

I forgot about it and thought I would just do FUE again as I have been researching transplants this year. Until I came across the theory recently, that a way to maximize lifetime grafts is to do a FUT-FUE combo. FUT first and FUE second. 
But in my case, if the Doctor left a strip, I hope it will work the same if I do the FUT second, after the FUE I already did, from the strip the doctor left hence maximizing lifetime grafts. 

Is this a good idea?

My worry is also if my donor has deteriorated over time that this might not be feasible. 

Below is the picture of my donor area, with the strip, hopefully visible, I'm guessing the more dense bit across the middle.

Is this a good idea? Can I get a few thousand grafts out of this and will the above hair be able to cover the scar?

Regards

[mr_peanutbutter]

yes why not, id consult with fut experts like hattingen though

[Westview]

You got tons of donor hair.

I would go with a FUT first

[tacale]

On 5/23/2024 at 4:05 PM, Westview said:

You got tons of donor hair.

I would go with a FUT first

Thanks for responding and raising my hope. I thought this would be considered thin. 
FUT first, because of the logic that FUT + FUE yields more total grafts?

[Davies]

What does the area look like which needs implants? Is it not best to go for another FUE and leave FUT option for a late time (if even needed?)

[tacale]

23 hours ago, Davies said:

What does the area look like which needs implants? Is it not best to go for another FUE and leave FUT option for a late time (if even needed?)

Thanks for asking. I have posted 2 pictures (one unstyled in light, one styled) of the area which needs the implants below
 

I guess doing FUE again first might also be an idea. Thanks for suggesting it. I had only read people suggest the FUT first then FUE combination to maximise grafts
Why would FUE first rather than FUT be better?  To potentially be able to avoid the FUE scar? 

I guess the disadvantage would be risking the doctor touching the FUT scar thereby ruining the potential to have the FUT in the future. 

Edited May 25 by tacale

[Eureka]

Hey man, I also think you could go the FUE route first as you don’t have a massive area to cover. Once you’ve exhausted the donor via FUE you could then look into an FUT should you lose any more hair. 

Edited May 26 by Silent123

[Rossybop]

4 hours ago, Silent123 said:

Hey man, I also think you could go the FUE route first as you don’t have a massive area to cover. Once you’ve exhausted the donor via FUE you could then look into an FUT should you lose any more hair. 

It looks like he has to cover the entire scalp? There's not much density across the top of his head.

[Westview]

On 5/24/2024 at 5:33 PM, tacale said:

Thanks for responding and raising my hope. I thought this would be considered thin. 
FUT first, because of the logic that FUT + FUE yields more total grafts?

FUT is also cheaper and takes less time to perform than FUE,

Recovery time is a bit longer though, but its not really a big deal

[TakeAction]

It's a simple mathematical fact that combining both methods will increase the number of lifetime grafts significantly. Usually around 3000, and pretty much always over 2000.

Think of the donor as a rectangle 30 x 6 cm = 180 cm^2. An average patient may have about 75 FU/cm. The entire donor area has 13.5k grafts.

If you were to do only FUE, you might be able to take 40% of the donor. 50% if you have good characteristics. That means you have about 5400-6750 grafts to extract via FUE alone.

If you were do only FUT, you might have enough laxity for 6000 or so grafts in your lifetime. Around the same as what you'd get with only FUE.

Back to the rectangle. A strip is typically somewhere around 40 cm^2, maybe around 30 cm long x 1.3 cm wide. A 40 cm strip with a density of 75 FU/cm gives you about 3000 grafts per strip x 2 = 6000 grafts from earlier.

So if you take about two of those strips that are 1.3 cm wide and 30 cm long from the rectangle, you've now reduced the rectangle from 30 x 6 to 30 x 3.4.

However, the FUT strips have not affected the density of the remaining 30 x 3.4 cm at all.

You can still take 40-50% of the 30 x 3.4 = 102 cm rectangle, which should have about 102 * 75 = 7650 grafts in total. So conservatively, 40 percent of that gives you another 7650 * 0.4 = 3060 grafts. If you take 50% of that area, you can take about 3800 more.

By combining the FUT and FUE you have approximately 6000 + 3060 = 9060 or about 9000 grafts in total conservatively, or 6000 + 3800 = 9800 if you take 50% via FUE.

So we're looking at 9-10k scalp grafts in a lifetime by maxing out both methods. Very few patients actually max out their donor so we rarely see this.

This is the main advantage of FUT.

[tacale]

2 hours ago, Westview said:

FUT is also cheaper and takes less time to perform than FUE,

Recovery time is a bit longer though, but its not really a big deal

I thought the big deal with FUT is that in older years when all the hair goes, the scar will be visible and look bad.

I guess also it can be harder to find the right doctor for it, and it needs to be one with experience performing FUT which not many do too much these days

Edited May 26 by tacale

[Westview]

On 5/26/2024 at 12:54 PM, tacale said:

I thought the big deal with FUT is that in older years when all the hair goes, the scar will be visible and look bad.

I guess also it can be harder to find the right doctor for it, and it needs to be one with experience performing FUT which not many do too much these days

If an FUT is done right there wont be any scar visible, and there are plenty of doctors who are good at doing FUT's.

Just stick with doctors recommended through this forum

[Davies]

On 5/25/2024 at 10:22 PM, tacale said:

Thanks for asking. I have posted 2 pictures (one unstyled in light, one styled) of the area which needs the implants below
 

I guess doing FUE again first might also be an idea. Thanks for suggesting it. I had only read people suggest the FUT first then FUE combination to maximise grafts
Why would FUE first rather than FUT be better?  To potentially be able to avoid the FUE scar? 

I guess the disadvantage would be risking the doctor touching the FUT scar thereby ruining the potential to have the FUT in the future. 

Looks like you have a good base already for hair top up work.