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FUE - STRIP confusion


#1

I’ve been an avid FUE guy due to invasive scars, I saw one doctor explain
the difference between amount of hair and amount of grafts and talk about true
donor size… Fox tests etc.

  1. Fue garners an estimate of 2000 hairs per surgery… up to 15hrs of work
  2. He can garner up to 8,000 hairs per strip …5 hours of work
  3. His patient scars are almost undetectable and he has hundrends of
    videos to show proof. Quite impressive. I have never seen such a log of
    awesome scars… lol

any feedback would be great.

Also I’m thinking if He can actually yeild that many hairs it is possible to
blend Fue with it for the final touch. I wouldnt want to go under the knife
again.


#2

Ok anybody chime in

So is it true Strip vs. Fue

  1. Strip can achieve 8000 hairs while fue can gather only 2000 hair per procedure?

  2. It really doesnt matter the amount of grafts we really want its the amount of hairs?

  3. If strip can yeild 8000 hairs and your donor site is avg. or below …
    Strip is the way to go, but you can still use FUE if more work is needed.

  4. Meaning …if one gets fue done on low density donor area there is less likely
    that you can get strip done?

The doctor that im not mentioning does incredible work. You can hardly see any visable line and im sure with tatooing
there would be no possibilty.

Im only even thinking this route is because I always had fine hair and think my hair donor is minimal or close to average
at best. Trust me I was always a big FUE fan.


#3

[quote][postedby]Originally Posted by 44guy[/postedby]
I’ve been an avid FUE guy due to invasive scars, I saw one doctor explain
the difference between amount of hair and amount of grafts and talk about true
donor size… Fox tests etc.

[/quote]

FOX test? Why is FOX test relevant these days? How long ago when you saw this doctor?


#4

[quote][postedby]Originally Posted by 44guy[/postedby]
Ok anybody chime in

So is it true Strip vs. Fue

  1. Strip can achieve 8000 hairs while fue can gather only 2000 hair per procedure?

  2. It really doesnt matter the amount of grafts we really want its the amount of hairs?

  3. If strip can yeild 8000 hairs and your donor site is avg. or below …
    Strip is the way to go, but you can still use FUE if more work is needed.

  4. Meaning …if one gets fue done on low density donor area there is less likely
    that you can get strip done?

The doctor that im not mentioning does incredible work. You can hardly see any visable line and im sure with tatooing
there would be no possibilty.

Im only even thinking this route is because I always had fine hair and think my hair donor is minimal or close to average
at best. Trust me I was always a big FUE fan.[/quote]

Hi 44guy,

I’ll address each of your points as best I can.

  1. Most people reading this are equating hair transplant surgery with grafts, not hairs, but it is a fact that some clinics will have more hairs per graft than others and some will have less hairs per graft so it is very appropriate to understand the differences. The official average number of hairs per follicular unit, as any clinic will tell you, is about 2.3 hairs per graft. The truth is something different but it is the basic line that every clinic is supposed to tell you. So keeping that in mind we’ll use the number of hairs translated to the number of grafts. 8000 hairs equates to 3473 grafts and 2000 hairs equates to 869 grafts. Are you certain you were told hairs and not grafts?

Strip can easily achieve higher numbers in one day. All the grafts are removed (essentially) at once and several technicians are preparing them. In fact, they are already being prepared before the donor wound is closed so there is a team effort advantage with strip. With the right team it is fast and efficient.

With FUE you have, at most, two people and usually only one, scoring the grafts. If you have two people working on you it is usually one person scoring and the other extracting. Some clinics will have two people scoring and extracting. I say “people” as a general reference because rarely is it a doctor and is usually one or two technicians.

  1. Yes, the amount of hairs is what matters. One man’s 3000 grafts is another man’s 2000 grafts, meaning, two people can get the same amount of hair transplanted but with two vastly different graft numbers.

  2. This depends on whether or not you even need 8000 hairs, or 3500 grafts. Strip is the way to go if your goal is to maximize your donor zone to it’s FULLEST hair count/graft count potential for the long haul.

If one’s donor density is average, then strip is fine, but with each subsequent strip the density will slightly diminish and the laxity will lessen. In addition, assuming you have an acceptable donor scar from the first surgery, your chances of having a wider scar increase exponentially with each pass. With below average donor density I think that strip is not the best option even on the first pass. Donor scars must be hidden and in order to hide donor scars density matters more than length . Even the thinnest of donor scars must be hidden and the lower the donor density is the longer the hair needs to be. Eventually, density can be reduced to the point that length is irrelevant.

  1. Yes, but as I said above, low density donor zones are not necessarily good candidates for strip to begin with. In fact, if strip is performed first it even goes further to reduce or eliminate the option of FUE later due to the requirement for density to conceal the resulting strip scar. If you have FUE after strip then you are reducing your donor density on a one to one ratio.

I’m a believer in the merits of strip surgery but I am also brutally honest about it’s limitations. If you have strip surgery, no matter how good your surgeon is, you run the risk of a wide donor scar. I don’t care who says otherwise because they are wrong or lying. Period. Full stop. Never EVER forget this fact. I’m also not a believer in big strip surgeries either. Why? Because not every surgery is going to grow to it’s fullest potential so if you get a big session, and your growth is poor, you just effed yourself by putting all of your eggs in one basket and putting that basket on your driveway, right behind the rear wheel of your truck.

There is no procedure that is an equalizer. Meaning, if you have low donor density you don’t have a mix of options that can make up for this deficiency. Don’t count on FUE into your donor scar, don’t count on scalp micropigmentation. Every procedure has it’s shortfalls and no procedure is a sure thing. When you start adding various additional approaches to solve a problem you wind up compounding the potential for failure, not success.


#5

Hello Hairsite,

tks for response,

Here is an excerpt from His web. I believe he still follows the protocol based
on the fact some people just shouldnt do FUE. Old School? i’m not sure, but as we
we know some people on here have not received great results with FUE. Would this the
underlining cause even with some well know doctors that abandoned the FOX test?

From his site:

Harvesting is done with a punch biopsy instrument or a neograft machine.
Harvesting can easily damage follicles by nipping the roots or tearing the
follicle. Some patients are not good candidates for FUE. Doctors should
conduct a FOX test to see if healthy follicles can be harvested from each
individual. In worst case scenarios, if harvesting fails,
the entire procedure could be shut down in mid-surgery due to
the lack of healthy follicles. See more about follicle damage.

The Doctor did go through a personal setback last year. His personal issues
I put asside, but his work is simply the best strip I have ever seen. I have never
seen more personal testimonies (clients) from this one doctor.

I dont list him here just incase there was a problem with promotions etc.


#6

Joe,

Thanks for your reply

I was hoping you would chime in due to your strip experience and current
postion on FUE. You are definately regarded as an expert in my opinion. And I will
take your advice to heart.


#7

(Easy to find info on this doctor, using your quote and Google).

From his website:

Bolton Bundles™ also known as multiple follicular units are grafts containing 2-3 follicular units or (4 to 8 hairs). THESE ARE NOT PLUGS, these are SLIT GRAFTS just the same as in micrografts or follicular units and they are NOT used in the frontal hairline. Instead, they are used behind the hairline to boost density up to two to three times!

This seems like a red flag to me… (the bolded part) Conventional wisdom is that the most natural results are from using individual follicular unit grafts, and not larger grafts that contain multiple follicular units, which can look pluggy.

I’ve heard of some doctors using larger grafts like this (Dr Ron Shapiro for example) in very limited ways, in order to build up specific areas of density. I don’t know if this is still the case with Dr Shapiro, who is reportedly one of the best doctors doing strips. But the danger is a pluggy-looking transplant. When transplanting, it’s normal for the graft to naturally contract/compress somewhat, leading to potential problems with larger grafts (a pluggy appearance) in the wrong hands. Larger grafts can contact and be actually more dense than your natural hair. That’s usually not good.

I do think it’s probably smart for doctors to use the procedures that they know the best - it seems like a lot of doctors have jumped on the FUE bandwagon strictly for financial reasons, and don’t necessarily do the best work. However, without knowing the specifics of this doctor’s procedures and how he uses them, it appears that he is using outdated techniques. Conventional wisdom is that the best strip surgeons transitioned to using individual follicular unit grafts (not multiples) over 15 years ago. Most doctors didn’t do it voluntarily, they were convinced because of superior results.

Also, this claim defies logic:

What Doctors Don’t Want You to Know

This ideology and Dr. Bolton’s trail blazing techniques invite a lot of opposition from competition because it means less money for doctors and more hair for the patient. His fervor for unequaled superior results places the Great Hair Transplants method of surgery in a class by himself. Doctors would rather give you less hair so you can have more surgeries and they can get paid multiple times when the reality is: MORE OFTEN THAN NOT, YOU ONLY NEED ONE GREAT HAIR TRANSPLANT!

If there was an easier procedure that gave superior results, every doctor would be doing it. Doctors are not trying to drag out the process, in order to get paid more. Most doctors think the procedures are too tedious, in my opinion.

Also, the doctor claims that his donor scars are “undetectable”. This has been an ongoing claim from the doctors since the earliest days of crude plug grafting (and quite often, it’s not true). If strip scars were as undetectable as claimed, there would be very little need or demand for the FUE procedure in the first place. FUE would only be a fringe minority procedure that only a few patients wanted (and not the fastest growing procedure in the industry). However, just because a doctor does FUE doesn’t mean he is competent. In my own case, I had FUE and BHT with Dr Cole (and wasted $36,000, as virtually none of the grafts grew). Don’t think that just because a doctor does FUE, that he deserves your trust.

This particular doctor may be very good - I wonder about him for reasons mentioned above, but I don’t know for sure. So try to see as many random patients as possible (not just the guys who work in the office - the reason they work there is to show off their good results). Look at their hair up close, and see if there is any evidence of plugginess. The more patients you can meet, the better. Don’t be shy about meeting patients! Also, realize that your results will hinge on your own personal characteristics, as well as the skill of the doctor. Look for patients who have similar patterns of hair loss as you, and similar hair characteristics - hair color, hair shaft diameter (coarseness). In other words, compare apples to apples, in order to know what to expect.

One more thing - when doctors have their own marketing terms for procedures, as this doctor does, that’s often a bad sign. It’s confusing for patients, and unnecessary “razzle dazzle”. The doctors should be educating the patients, not trying to sell them with marketing techniques. This alone isn’t a deal breaker, but it shows where the doctors’ priorities are: profits (and it’s all too common).


#8

Hey Arfy, Good Job!, But did you go to this guys site?? Crazy isnt it? I have
never seen such work with strip… to be honest he seems pretty artistic??
there has got to be on his site and youtube 100s of videos up close and
you can barley see the scar. The guy is pretty cool to boot… If he actually did Fue
with experience i would consider it.

As Joe said though since I have low density hair strip may not be the best for me


#9

Since we now know whom you’re referencing I will say this. Only a couple of years ago he was shown removing a strip on Youtube with a multi-blade scalpel handle. This harvests a donor strip in about ten minutes including coffee break. It also destroys a sh*t-ton of grafts due to transection. if you have strip, ONLY have it with a doctor that is proficient with a single blade scalpel, among a hundred other things.


#10

“Bundled grafts” like this doctor uses (besides the issue of graft compression/potential plugginess) are not an efficient use of donor hair. Individual follicular units can be distributed to cover more area. Along with the multi-bladed strip harvesting method that Joe Tillman brings up, these are red flags: This doctor (IMO) who is probably not very good at conserving your precious donor supply. For most patients, that is a crucial issue.

Also, lots of doctors can show impressive Before/After photos, including the worst doctors in the business. Photos on their website don’t tell the whole story. For one thing, photos can often be deceiving (even when they aren’t intended to). They flatten out a 3-dimensional object (your head) and don’t allow viewing from multiple angles. You can miss a lot of details, even in the best photos. You don’t see how light plays across the surface of the scalp (whether the grafts look bumpy or pitted). You can’t run your fingers through a photograph, to see signs of plugginess. Also, lets say a doctor shows 10 knockout patient results on his website… great! But what about the 90 other guys he transplanted last year, what were their results? (What is the doctor’s consistency?) Patients need to evaluate multiple factors, and photos can be helpful but they aren’t the end-all factor. “Doing your research” is way too complicated (and prone to error). I wish it was as simple as looking at their website’s photos, because then researching a doctor would be extremely easy. But it’s not.


#11

Never trust photos.
In this era of technology where children share hd video, there is absolutely no excuse to primarily rely on photos unless you have something to hide.

And beware of videos which show only selective scenes, like a comb running through a hairline forever but scant view of where all the other “thousands” of grafts went.

From having a look at results, I conclude things have improved, but the amount of grafts used to cover given areas just does not add up.

So, either the transection rates are massive, the implantation is rapid, blunt and traumatic, or the doctor is simply lying about graft numbers…which artificially makes it look like a cheap cost per graft. From what I see, this is a widespread and endemic practice.

Strip more often than not leaves nasty wide scars. On the positive side, the damage is limited to one section.
FUE scarring is far less, but on the negative side, over zealous rapid fire hole punching can seriously deplete an entire donor in an hour or two. A percentage of follicles may be intact, but a very large number will be transected and useless…but at least you get the useless follicles at a cheaper price.

In strip, dissecting out individual follicular units without significant transection is common. The tech sees the transections as the straight blade cuts through bendy follicles.
In FUE, THE STRAIGHT PUNCH cuts through bendy follicles , but the tech doesnt know it until they pull it out.

The more you educate yourself the better, always read the Disclaimer BEFORE surgery, and BUYER BEWARE, as the law protects the perpetrator, and rarely the victim.

Dr Ray Woods