FUE vs. Strip

[heelz]

I am 26 years old and trying to determine which procedure would be best in my case. I have been told I would need approximately 1800 FU's (Norwood 3) and that I have higher then average density in the donor area, but more 1 and 2 unit grafts vs. 3 and 4 unit grafts. I also have thin, wavy hair. I have consulted with two different physicians and both had different plans. One recommended FUE, the other strip. I understand the basic differences (i.e. cost, harvest methods).

 

My questionss are more specific and generally come from the 2 consultation I have had.

 

1) Does FUE generally have lower yield then strip method due to damage that occurs during folicle harvest?

 

2) Does FUE cause more damage to surrounding donor hair then strip, therefore lessening the potential of future transplants should one be needed?

 

3) How quickly does FUE heal compared to strip?

 

4) Is 1800 FU's too much for FUE (seems to be right at the cusp for 1 transplant procedure)?

 

 

As you can tell, I somewhat lean to FUE procedure due to the fact of my age and I have always kept my hair fairly short. However, I would rather undergo one procedure vs. two procedures over a short amount of time to correct for hair loss. I also do not want to put the remainder of my donor hair at a significantly higher risk of damage, in case I may need it for a future procedure. Any helpful advice is much appreciated.

[Sparky]

go with FUE, it is slightly less yield in some cases. In my situation striphas caused far more damage than FUE would have done, that now I am having my scar fixed with FUE, the actual hairs that I had transplanted in the first place to be exact. FUE now wouldnt stop you from having strip in the future.

 

You like to keep your hair short, atm I cant go below an inch at the back because of the scar, but I had a shite surgeon, some peoples strip scars, are very hard to find.

 

1800 grafts isnt a lot, I know someone who has had 7000 FUE and his whole head has been restored, with no scarring that I can see.

 

I think that FUE heals much faster.

 

You will get a lot of people saying strip is better on here, most of them seem to of had that method, but my personal opinion is to go for FUE first time around.

[thanatopsis_awry]

Honestly, it really just depends on who you go to. An ~1800 FUE session may or may not be effective based upon *who* you are actually going to -- some FUE docs are simply unreliable and shouldn't be gone to for any #, some are reliable but aren't willing or capable of realistically achieving the graft number you want, etc.

 

You're only 26, and a NW3. I would plan as if you are going to lose more; thus, you will require at least another FUE session. Are you prepared to financially commit to this? If so, great.

 

Question 2 is an interesting one. It certainly seems that FUE produces more trauma, and even scarring, to your donor; whether going about FUE right now could hinder your ability to *max* out your donor later on, I'm not sure, and I've heard different things. I do feel that going the route of strip, and then finishing yourself off with FUE is the best to max out your donor.

 

Also, going back to what I mentioned before about committing to future procedures -- I also meant a commitment to FUE. The benefits as I see them of going FUE to begin with are only maximized if you don't plan on doing strip anytime soon (decades).

 

One final thing...1800 is a good number for FUE, but especially for a hairline case you *really* want to get the right # of hair transplanted. I haven't seen your pics, but I would want to be absolutely sure 1800 would be a perfect number for satisfying me, particularly has your yield may very well be a bit lower with FUE vs. strip.

[Sparky]

I dont think that strip or fue would be nessasary in decades. Hopefully they will have sorted this problem by then.

[Severn]

Originally posted by Sparky:

I dont think that strip or fue would be nessasary in decades. Hopefully they will have sorted this problem by then.

 

I can't imagine any big discovery that would beat a high quality HT anytime soon. I guess the next breakthrough will be with genetic engineering, but I would assume that is a minimum of 20 years away. I may not be alive in 20 years!

[thanatopsis_awry]

Hopefully. And I guess there's reason to believe this might be sorted out within 20 (10?) years...but there really hasn't been a breakthrough, or even the true seeds of one. There's promising logic and experimentation, but I feel like we get fed a lot of smoke and mirrors on this stuff and the scientists are in fact in the dark, as we are.

 

It's just as, if not more likely that our breakthrough comes from a totally unexpected and serendipitous avenue -- and you can't really put a time frame on that, other than saying that it will eventually come.

 

Anyways, I only mentioned "decades" as an arbitrary number, and I probably shouldn't have even said that -- regardless of what number gets plugged in I think the benefit of FUE is greatly increased the more likely and longer you go without switching over to strip.

[Dr. Scott Alexander MD]

Heelz,

Since you are only 26 years of age, and already a Norwood 3 I can guarantee you that you will need more work in the future. There is a good chance that you would need more grafts than 1800 if it is dense packed for a Norwood 3. If you have your surgery done by the right doctor the strip scar should be almost as invisible as the fue's. The FUEs will feel better quicker in the back than a strip. Most strip surgeries feel fine at one week. You are only talking about a few days difference. There is a good chance that you will have numbness in the donor area after both procedures. The difference between FUE and strip at this point would be tiny micro scars throughout your donor area vs. a normal scalp except for a fine line scar with a strip. I think it would be much better as thanatopsis stated that you protect the rest of your donor area for future surgeries with a strip method now and once you are tapped out you'll always have the option for FUE. You need to be sure and look at the overall transplant quality of the doctor's work as opposed to if he just does FUE or not. I do FUE, but not as frequently as others.

[the B spot]

Generally speaking, my personal feeling on FUE or Strip questions is:

 

1. 30 and under

2. 2500 grafts or less needed.

3. may or may not need some future work

4. Likes to wear hair short

5. Expresses some trepidation over having a strip scar.

 

I think for the most part I would like to see patients fitting this profile strongly consider FUE as a first option. Obviously, there are those who could care less about a strip scar, and others who will never do anything but FUE, regardless of cost/time/yield, but for those doing their research and on the fence..I believe if they end up choosing a proper clinic to perform the FUE session, they will be happy with the choice. Both short and long term.

 

Again, note the smaller session sizes and the relatively low impact on the donor region overall. When you start taking higher numbers or a high percentage of donor, other prohibitive factors such as donor depletion, noticeable scarring, lower overall yield compared to strip and cost are elevated.

 

Hope this helps out.

 

Take Care,

Jason

[hairlust]

Jason is right on this one.I think fue would be a good choice. Speaking asa strip guy myself, i can tell you that the linear scar in the back of the head really affects the way you wear your hair, my scar is visible even at a #2 guard!! sINce youre only a norwood three,

try fue, and definittely go on fin, this way ypou stabilize your future loss and by doing fue you wont have the horrible "smiley face" in the back of your noggin'. The reason i settled for strip is because it was cheaper and it only took 5 hours in operating room.

TC

[heelz]

I really appreciate everyone's comments, please keep them coming. I personally feel like you can never have to much information, especially when considering surgery.

 

Dr. Alexander, you noted that you perform FUE in some patients, but also stated that you feel strip may be warranted in my case to protect future donor supply. First, what patients do you typically recommend FUE for, and secondly does FUE use more of your donor supply then a strip procedure?

 

Once again, thanks for all the commentary. Hopefully being more informed will make the decision easier.

[heelz]

One last question Dr. Alexander, you also noted that I would likely require a 2nd procedure at some point due to my age. How long does the first surgery typically hold for before a second procedure is required? I know this is a somewhat difficult question to answer and is likely based on genetics. My maternal uncle is a Norwood 6 or 7. He is the only family member with really any noticeable baldness. Neither my Dad or my brother have any recession, nor does my uncle's son (age 36). I really do not have grandfather history to rely upon as both were deceased before I was born. Hope this helps.

[vincehair]

Heelz,

the main thing that scares me about strip is the possible nerve damage. I have read several patient stories over the years where they stated that they never got the feeling back in their donor. That is scary.

 

Whats the point of having beautiful women run their fingers thru your hair when you cant even feel it? Seriously

 

Also,yes FUE leaves little white dot scars but can FUE scars stretch to several mm wide??? Exactly.

 

Hard decision hey?

[baqu]

Vincehair,

 

I was in the same shoes about 6 months ago. In the end i chose strip with a coalition clinic here and I'm now 6 weeks post-op and waiting for results to come along.

 

Do your research. Independent forums will give you more balanced info then sites paid/sponsored by clinics.

 

I came to the conclusion that there were just too many inconsistent results of yield from FUE and in the end chose strip. I have seen great results from fue, but on the whole the lack of yield issue was the deciding factor for me. I could not afford to start the HT trail, have a new hairline after an HT and bad density around it. Not only a waste of donor/money/time but also the emotional stress of going thru another HT to fix something that should have have been done first time round.

 

Regarding bad donor strips, i found that they mainly fall into 2 categories, surgeries done many years ago and bad doctors.

 

Remember, do you research and good luck with your plans.

[TheEmperor]

Originally posted by baqu:

Regarding bad donor strips, i found that they mainly fall into 2 categories, surgeries done many years ago and bad doctors.

 

NO! I went to a top5 doc and my scar is 3-4mm throughout. It was that width from the beginning, didnt stretch, was always wide, and had tricho closure.

 

I have to keep my hair 1.5 inches to hide the scar. Wind or combing through it is quite obvious. If it wasnt for fear of the scar being wider next time, I would have gone back for a second procedure, might even consider myself "done".

 

Wide scars are a matter of opinion, and more prevalent than you might think, and they happen from the best docs.

 

4mm may not sound wide. It looks like Bill scar, maybe a touch wider. But fine hair cannot really cover it well.

[hairlust]

The emperor is right, scars will be wide and if not wide , you still cannot buzz your hair to short because the smiley face will be mugging everyone staring at the back of youre head. I think it all comes down to vanity and money . If you dont care about the scar and you dont want to spend a fortune (face it fue is expensive compared to strip) then go for it. I had 3 strips and my results were pretty good,but i wont be going for the jason statham look any time soon.

[the B spot]

Lesser than optimal scars do happen, at every clinic. This is 100% true. WHY they happen can be a mystery sometimes, but they still happen.

 

However, a less than optimal scar should be brought to your doctors attention and they should fix it.

 

Using Emperor as an example, if his scar is 4mm wide and he has had only one session, taking a .5cm or 5mm strip to reduce the scars appearance should be no trouble and result in a better scar...unless of course the donor was subjected to extreme tension, but even then, just remove the scar tissue should result in a better scar.

 

What makes a top clinic "Top" is not just the results over the long term, it is how they treat the occasional patient who experiences issues such as a wider scar, etc... making them a patient for life, not just the session.

 

This particular topic is often heated on either side with no "right" answer. I like the idea of some future options, especially for patients under 30 needing less than 2500 grafts. It does not make me right or wrong, it is just my opinion.

 

I hope that when people read my points and the other points raised, they can think about which approach might be best for them..but do so, not from a "fear" or unknown standpoint, but with some solid information.

 

Take Care,

Jason

[Severn]

Originally posted by TheEmperor:

[

NO! I went to a top5 doc and my scar is 3-4mm throughout. It was that width from the beginning, didnt stretch, was always wide, and had tricho closure.

 

 

 

If it was that wide from the start, that has to mean they badly overestimated the laxity and couldn't get a complete closure.

[heelz]

Speaking to FUE yield. Has the yield improved recently? I know Dr. Feller had released a new tool somewhat recently. I'm sure it was studied prior to release. How do the results from the newest FUE technology compare to previous surgeries? Is there a good place to seek out before and after photos for FUE surgeries, as they are much less prevalent here and you have to click on many people's sites just to find a couple FUE surgeries with good pictures.

[thanatopsis_awry]

FUE yield has certainly risen in the hands of a select few. Dr. Feller's recent instrument is certainly a major player in the developments that have led to increased yield across the board.

 

It def is harder to find FUE results, especially from doctors that don't specialize. However, I know Spex/Feller has posted several lengthy montages and listings of their FUE; you might want to contact Spex directly to find out more if you can't easily find the threads.

 

I would directly contact all of the FUE clinics you are considering and have them get back to you with whatever they have.

[the B spot]

Heelz---I want to respond to you here as other then a few clinics, there seems to be a dearth of true FUE results posted regularly.

 

It is true that SMG is performing FUE now, but we are just getting to the point where our first hairline patients will be sharing their results in the coming months. I have said from the start that while I believe patients should put their trust in SMG via FUE based on our long history of excellent results, I 100% support those who want to see grown out results before making a choice.

 

Dr. Feller is certainly an excellent choice for FUE and has my full recommendation. I think it is silly not to consult with him for FUE.

 

As far as yield, I think FUE yield is near strip yield when performed properly and without "speed stress" tossed into the mix. I also believe that .9-1.0mm punches allow FUE to get any grafts from any patients. Smaller is always nice, larger than 1.0mm is not necessary and increases the risk of noticeable scarring.

 

Again, there is much disputed information, but it seems clinics who maintain excellent quality control and refuse to bow to the economics of doing several patients a day or targeting massive numbers of grafts per day, get good yield and nice results.

 

I realize FUE might not be prevalent here, but in time that will change going forward as real results will show out over time.

 

Take Care,

Jason

[heelz]

B Spot, check your PM

 

Thanks.