Dear readers,
I hope you enjoyed your vacations as much as I did mine.
A frequent query of patients is that they want to see actual previous patient’s inputs. In terms of what it looks like immediately after, a week later and what different graft numbers turn out to be in terms of cosmetic coverage.
Many of our patients have taken the time and effort to compile their follow ups and results.
The least, I feel, I can do to thank them is to compile them on a thread so that future hairloss sufferers can go over their experience and benefit from that.
The first and foremost, of course, is this thread from the old forum where more than 40 results were placed. It also contains valuable insights from doctors and patients alike.
I will consider this essential reading for anyone considering a hair restoration.
You can go over results, shared thoughts as well as the inevitable counter views.
I notice that there are still no 5000ish or more FUSE transplants. does Dr. A and your clinic still maintain that more grafts can be got from FUSE alone compared with strip or FUSe/strip combos. The current “wisdom” on the board is that both are needed to maximize yield and there remains little or no evidence to the contrary.
» Thanks for the compilation Dr. R.
»
» I notice that there are still no 5000ish or more FUSE transplants. does
» Dr. A and your clinic still maintain that more grafts can be got from FUSE
» alone compared with strip or FUSe/strip combos. The current “wisdom” on the
» board is that both are needed to maximize yield and there remains little or
» no evidence to the contrary.
»
» Thanks,
» Marco.
The limit on the number of grafts that can be taken out by FUSE/fue is determined by how short hair length the person wishes to keep.
Extracting in a random pattern, so that no adjacent follicular units are extracted, ensures that the patient can buzz cut his hair. However, that also means that only 20 to 25% of the available donor grafts are extracted.
Extracting adjacent follicular units, say 3 adjacent ones, will lead to visible empty spacing that may be conspicuous when the scalp is shaved.
If the hair length requirement goes from buzz cut Number 0 to buzz cut Number 2, then, accordingly more grafts can be extracted.
It is this requirement that limits the number of grafts that can be extracted from a particular scalp donor area by FUSE/fue. Else, I do not see any problem being able to extract, hypothetically, even 50% of the scalp donor.
In this picture the grafts have been extracted from the scalp donor while adhering to the pattern. Is it possible to extract more, if we keep the donor sites closer together? Yes.
Please correct me if I am wrong but based on this strategy which I am sure is a fundamental truth for all FUE practices then
I will take 25% as the safe value for this argument.
I will take 150cm2 as the average total safe regeon and 100 FU/cm2.
So, of 15000 safe FUs 3750 FUE will be the “ideal” maximum that allows total freedom of style and no “moth eaten” look. I remember that Dr. A mentioned 5000 could give a moth eaten look.
This number does seem consistent with the usual maximum FUEs numbers taken from several clinics.
I did appreciate that you have made it clear that more can be taken with longer hair but I think it remains a totally valid question as to why H&W as well as yourselves can take so many more grafts by strip. I would like to play devils advocate and suggest that there is a sense of denial by FUE surgeons to accept that FUE is more limited than strip in terms of numbers available. In the same provocation I would suggest that only by facing this “fact” and asking the question why, can the limitation with FUE numbers be overcome.
As Dr. A knows, my hypothesis is that the scalp reduction aspect of strip is not observed in FUE and this is the limiting factor with FUE numbers. By this I mean that the empty space left by FUE is not left in a strip procedure if the surrounding tissue is undermined adequately. The remaining FUs in an expertly performed strip are not thinned as noticeably as should be expected. I wonder if this is because there is a degree of lift at the nape and periphery of the occipital hair. This hypothesis lends itself to the idea that the tissue should be undermined during FUE to allow retraction of the removed tissue so that the density can be retained and then as many FUs could be removed by FUE as by strip and we would all live happily ever after. As stupid as this may all sound there are point that, at the risk of being shot down, are worth arguing out.
» As Dr. A knows, my hypothesis is that the scalp reduction aspect of strip
» is not observed in FUE and this is the limiting factor with FUE numbers.
» By this I mean that the empty space left by FUE is not left in a strip
» procedure if the surrounding tissue is undermined adequately. The
» remaining FUs in an expertly performed strip are not thinned as noticeably
» as should be expected. I wonder if this is because there is a degree of
» lift at the nape and periphery of the occipital hair. This hypothesis
» lends itself to the idea that the tissue should be undermined during FUE
» to allow retraction of the removed tissue so that the density can be
» retained and then as many FUs could be removed by FUE as by strip and we
» would all live happily ever after. As stupid as this may all sound there
» are point that, at the risk of being shot down, are worth arguing out.
Dear Marco,
Thank you for your input.
Two things -
When tissue is extracted and healing takes place, (since the underlying skull size does not reduce), the remaining tissue has to accomodate.
In strip, the stretch is experienced by the scalp above and below the suture line.
In FUSE/fue, the stretch is in the complete 360 degrees.
An easy way to visualize this is to think of the fue wound to be a circle that is contracting from all round its circumference.
Now, imagine a lot of such contracting circles going right down till the nape of the neck, below the nuchal ridge.
Theoretically, undermining the fue donor area MAY lead to an ability to extract more FUs per sq cms in repeat sessions. However, that will take away one of the prime benefits of fue. That being, fue does not significantly alter the position of the scalp in relation to the underlying skull.
An alternate way to increase the number of grafts by FUSE/fue is to follow the approach of “depixelizing and repixelizing”. That is thin out the donor areas and fill in the recipient areas so that the complete scalp has a uniform hair coverage.
However, I do not think that is a valid option for anyone who has dense pre existent hair growth anywhere in the scalp (other than the donor). The contrast will stand out.
So, this approach can be followed when one reaches the NW 6 stage.
I will ultimately need about 6000fu transplant and I am still asking the question as to what approach to use.
I remain confused as to why strip can extract more grafts and actually I am still asking whether strip can extract more grafts with a less thinned out look.
» Thank you Dr. A,
»
» I will ultimately need about 6000fu transplant and I am still asking the
» question as to what approach to use.
»
» I remain confused as to why strip can extract more grafts and actually I
» am still asking whether strip can extract more grafts with a less thinned
» out look.
When are you guys going to update your website with new pics?
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