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If you were gaurenteed a pencil thin scar


#1

If you were gurenteed a pencil thin (less than 2mm) scar for 4000 grafts in a strip session then in the current state of the art, would you go for a strip or FUE?


#2

» If you were gurenteed a pencil thin (less than 2mm) scar for 4000 grafts in
» a strip session then in the current state of the art, would you go for a
» strip or FUE?

In your scenario, does 4000 FUE garantee 4000 grafts growing?

Do you have the choice in this scenario of a 0.75mm-1.0mm punch or over that size range?


#3

» » If you were gurenteed a pencil thin (less than 2mm) scar for 4000 grafts
» in
» » a strip session then in the current state of the art, would you go for
» a
» » strip or FUE?
»
» In your scenario, does 4000 FUE garantee 4000 grafts growing?
»
» Do you have the choice in this scenario of a 0.75mm-1.0mm punch or over
» that size range?

Hairtech_ read it as state of the art and whatever that means to the person making the choice.

I am linking in here the reason for the question and linking it from the post above which is an H&W result since I was asked to start this as a seperate thread.

Well here is the thing. FUE allows you to shave the head. Joetronic will argue… why do you want to shave your head if you get a transplant???

The answer is simple. If we progress after some transplants to the point that flowing locks are not possible due to donor exhaustion or worse still uncoverable extending bald patches emerge that have no donor left to cover them, then if a strip has been performed it is not really possible to shave.

So, if you get a strip you need to know that continuation will server you well over a life time. With FUE you do not have to worry but unfortunately you will be more likely to get into that very predicament because most including me believe that the evidence is that you can get more FU from strip (scalp). And there is the rub.


#4

Agreed, and its not just about shaving your head. What if you want to keep your hair very short on the sides? For a good many people, hair just looks better that way.

But I do have one question. What is the evidence that you can get more FU from strip that FUE? Both take hairs from the donor area, and I would imagine that any hair that can be harvested by strip can be harvested by FUE. Then take that you have access to a much wider swath of the donor area than with strip and … well you get where I’m going.

» Hairtech_ read it as state of the art and whatever that means to the
» person making the choice.
»
» I am linking in here the reason for the question and liking it from the
» above which is an H&W result since I was asked to start this as a seperate
» thread.
»
» Well here is the thing. FUE allows you to shave the head. Joetronic will
» argue… why do you want to shave your head if you get a transplant???
»
» The answer is simple. If we progress after some transplants to the point
» that flowing locks are not possible due to donor exhaustion or worse still
» uncoverable extending bald patches emerge that have no donor left to cover
» them, then if a strip has been performed it is not really possible.
»
» So, if you get a strip you need to know that continuation will server you
» well over a life time. With FUE you do not have to worry but unfortunately
» you will be more likely to get into that very predicament because most
» including me believe that the evidence is that you can get more FU from
» strip (scalp). And there is the rub.


#5

» Agreed, and its not just about shaving your head. What if you want to keep
» your hair very short on the sides? For a good many people, hair just looks
» better that way.
»
» But I do have one question. What is the evidence that you can get more FU
» from strip that FUE? Both take hairs from the donor area, and I would
» imagine that any hair that can be harvested by strip can be harvested by
» FUE. Then take that you have access to a much wider swath of the donor
» area than with strip and … well you get where I’m going.

Yeh sure. It is just that at the momment the weight of evidence is that you cannot that easily remove the FU by FUE that were meant to be theoretically possible. Most surgeons say only remove 25% if you want to keep the hair short or it will look moth eaten. I know what you are saying though and it is logical. Maybe the jurry is still out.


#6

N/T


#7

But this is just an issue of the distribution of the grafts removed. If you can only remove a certain number of grafts by FUE, then you cannot remove more than that by strip without a similar loss in donor density. In both cases, you are simply removing a certain number of hairs from the donor region. With strip, the only difference is that you are removing a chunk of skin, with that hair, and stretching the rest of the donor to cover the missing chunk, thereby lowering the density of the remaining donor.

I would even guess, and this is just a guess, that for most people, scalp elasticity would first be a hindering factor in the amount of hair you could remove from strip long before thinned out donor density is, and if that’s the case, you should be able to harvest even less from strip than from FUE.

» Yeh sure. It is just that at the momment the weight of evidence is that
» you cannot that easily remove the FU by FUE that were meant to be
» theoretically possible. Most surgeons say only remove 25% if you want to
» keep the hair short or it will look moth eaten. I know what you are saying
» though and it is logical. Maybe the jurry is still out.


#8

» But this is just an issue of the distribution of the grafts removed. If
» you can only remove a certain number of grafts by FUE, then you cannot
» remove more than that by strip without a similar loss in donor density.
» In both cases, you are simply removing a certain number of hairs from the
» donor region. With strip, the only difference is that you are removing a
» chunk of skin, with that hair, and stretching the rest of the donor to
» cover the missing chunk, thereby lowering the density of the remaining
» donor.
»
» I would even guess, and this is just a guess, that for most people, scalp
» elasticity would first be a hindering factor in the amount of hair you
» could remove from strip long before thinned out donor density is, and if
» that’s the case, you should be able to harvest even less from strip than
» from FUE.
»

Yep, I don’t get it either. What you are saying seems logical and has been discussed many times. Is it because the hairline at the nape is moved with strip or maybe you are right and we will see more megga FUE sessions of the quality of H&W using scalp hair. They are not comming at the rate I expected if at all.


#9

I guarantee that this will be a moot point in a couple of years. Strip surgery will be a thing of the past. Only a handfull of clinics will offer them since most strip shops will go out of business. I imagine that Bosley’s businees will be hit hard since they will not do FUE. It is just a matter of time before most smart clinics will only do FUE. Just my take on it.


#10

If I could hazard a guess, I would say that perhaps the key word in this equation is “H&W”. I really have seen no clinic, strip or FUE, ever approach the level of consistent quality that H&W does. I can’t guess why, past the obvious observation that they are two very fine surgeons who have the technique and the ‘touch’ required.

We often hear of the lack of results in FUE approaching the H&W level but really, the same could be said about most strip. Hence my comment in the other thread to Jotronic.

» Yep, I don’t get it either. What you are saying seems logical and has been
» discussed many times. Is it because the hairline at the nape is moved with
» strip or maybe you are right and we will see more megga FUE sessions of
» the quality of H&W using scalp hair. They are not comming at the rate I
» expected if at all.


#11

» I guarantee that this will be a moot point in a couple of years. Strip
» surgery will be a thing of the past. Only a handfull of clinics will offer
» them since most strip shops will go out of business. I imagine that
» Bosley’s businees will be hit hard since they will not do FUE. It is just
» a matter of time before most smart clinics will only do FUE. Just my take
» on it.

Yeah right, FUE has been around for at least 5-7 years, still I can count the # of doctors who do FUE in one hand. What makes you think that the next couple years things will change so radically?


#12

» If I could hazard a guess, I would say that perhaps the key word in this
» equation is “H&W”. I really have seen no clinic, strip or FUE, ever
» approach the level of consistent quality that H&W does. I can’t guess
» why, past the obvious observation that they are two very fine surgeons who
» have the technique and the ‘touch’ required.
»

totally, when you see a clinic turning out results that fly in the face of all others it almost makes one suspicious but I think your explanation is probably the truth of it.


#13

» If you were gurenteed a pencil thin (less than 2mm) scar for 4000 grafts in
» a strip session then in the current state of the art, would you go for a
» strip or FUE?

I would not go for strip again, even if I knew in advance it would be a pencil line scar. The scar can be covered, sorry … has to be covered. The pain in the donor area can not be covered.

FUE is replacing strip as the prefered method of choice. FUE already has proven to be the choice of patients, now hopefully more surgeons will ‘see the light’.

Greetz


#14

I agree and disagree with you BVerotti. I don’t know if FUE will ever be able to fully replace strip. However your point about pain is something folks overlook.

My opinion is this about learning how to do FUE. And this is my opinion based on what I have seen the last few years:

  1. FUE follows two diciplines:
    A. Sharp dissection.
    B. Blunt dissection.

The sharp dissection can be learned but takes more time to get a good “feel” unless an increased punch diameter is used. This helps lower the learning curve to get an intact follicle but provides an increased peripheral transection potential.

Blunt dissection can be learned quickly by a physician because it is a simple score (around the follicle) and push with a blunt punch (into the dermis). The smaller punch diameter can be employed right off the bat and has less trauma to the donor area as well as graft protection from the dull punch.

Now sharp dissection and small diameter punches CAN be learned and utilized with great effectiveness but it takes more practice. But once you get it you got it!

In summary, both diciplines are effective. One takes(on average) longer to learn.


#15

» If you were gurenteed a pencil thin (less than 2mm) scar for 4000 grafts in
» a strip session then in the current state of the art, would you go for a
» strip or FUE?

Dont the strip docs keep churning out cases every day. There are still few wow results.

Even H n W will, at estimate, be doing 600 megasession cases a yaer. We dont see that many end wow results for the megasessions they be doing.


#16

There was this debate on another forum, I couldn’t find the quote but basically it said that FUE can not give the same numbers as Strip and that if the density is too low and the NW class to high FUE may not be suitable anyway.

Removing a strip of 1.5cm or so is going to do hardly anything to the surrounding density, but if you start to remove 30-40 or 50% of the follicular units in a cm2 it is going to make a massive difference to the look.


#17

I know you’re just repeating what you’ve read in another thread on another forum, but truthfully that doesn’t make any sense at all.

Are you suggesting that if you remove say, 3000 grafts by strip, this will have less effect on the donor region density than if you remove 3000 grafts by FUE?

Please explain the logic here. In either case, you’ve taken the same number of grafts from the same area, resulting in the same final donor density.

» There was this debate on another forum, I couldn’t find the quote but
» basically it said that FUE can not give the same numbers as Strip and that
» if the density is too low and the NW class to high FUE may not be suitable
» anyway.
»
» Removing a strip of 1.5cm or so is going to do hardly anything to the
» surrounding density, but if you start to remove 30-40 or 50% of the
» follicular units in a cm2 it is going to make a massive difference to the
» look.


#18

Can you remove more grafts via FUE, Strip or a combination of the two?

Lets look at the numbers:

Lets say that your Donor zone is 20cm x 6cm. Lets say that you have a fairly modest density of 80 FUs per cm2. This would equate to 9600 FUs in this donor zone.

Now for argument, lets say you could remove 40% of the FUs via FUE from this region without looking “moth eaten”. 9600 x 0.40 = 3840 FUs from this region via FUE.

So FUE = 3840 FUs

Now, say you remove a strip from this region of the following dimensions:
20cm x 2cm (Transections aside), this would yield 3200 FUs from this ONE region. The wound is stitched closed and it effectively “disapears” BUT you still have the 20cm x 2cm above it and the 20cm x 2cm below it.

100% of the grafts from this region are removed but without the loss of density to the eye. If you were to FUE 3200 FUs from this ONE region you would have a bald strip 20cm x 2cm - so it can not be done.

So strip alone = 3200 Fus.

But, like I say, you still have the 20cm x 2cm above and below this strip area. If you can take a second strip then again that would equal 3200 giving you a total of 6400 FUs from 2 strips (the second strip depends on your scalp laxity and many second strips are not of the same dimension as the first).

Many people find it hard to grasp that Strip surgery does not alter the density of your donor but it is simple. Density in hair transplant surgery refers to the the number of FUs per cm2. If you have 80 FUs per cm2 and you remove the afformentioned strip, your donor density has not been reduced because you still have 80 FUs per cm2 (dont forget the place where the strip was taken effectively disapears) - you just have a “smaller” donor area now. FUE on the other hand will reduce the density of your donor region because you will have less than 80 FUs per cm2 after surgery - it is just terminology.

So, some scenarios:

  1. You are able to remove another strip which would equal another 3200 FUs which means from 2 strips you have a total graft count of 6400 FUs for transplanting. Again from ONE region only without the loss of density to the naked eye.

2 x strips (if scalp laxity permits) = 6400 Fus.

  1. You are only able to take one strip and then FUE at the rate of 40% above and below it. So, 3200 FUs from your strip surgery. You then have 2 x 20cm x 2cm left. 20 x 2 = 40 x 80 = 3200 x 2 = 6400 x 0.4 = 2560

Combination of FUE + Strip = 3200 + 2560 = 5760.

Now the what ifs… This assumes that for 2 strips the same amount of grafts are harvested but I believe this is rarely the case UNLESS you have masses of scalp laxity. Here it would be interesting to see if JOTRONIC could supply data for

  1. the average strip length and width.
  2. The average number of FUs per person on this strip and
  3. the average second strip length and width.

If you have “terrible” scalp laxity then based on the above FUE only would be the way to go. If you have fantastic laxity then strip would yield more grafts. If you have an average laxity, I think you would get the most bang for your buck with 1 strip and then FUE (or FUE first but leave the “strip zone” untouched). So, it is not an exact science and is quite individual depending on your unique characteristics and is not a question that can easily be answered generally.

But…

The above also does not take into account that FUE can go to places that strip can’t - how many grafts are available in these areas? I believe that you CAN “overharvest” some areas with FUE without any worries for example the bottom 1cm all around the lower part of the donor area - most people have this tapered in a haircut anyway - if this region extends for 40cm with 1 cm in width with 80 FUs per cm2 - lets say you can remove 60% here, this would give you 40 x 80 = 3200 x 0.6 = 1920 from just that region. My nape area has approx 2640 FUs ie 4cm x 3cm at 110 FUs per cm = 1320 x 2 = 2640 which be a great number for a hairline.

Strip will also not allow you to go for the less is more look.

It will not allow you to buzz cut and in many cases not even enjoy a shorter haircut.

I know the thread here guarentees a very thin scar but again, this can not ever be guarenteed and I personally think you are in good hands with many surgeons but I for one would not allow my head to be carved up.

So based on my research, I would not go for strip at all - I want options and strip will NOT give me those options.


#19

That was a great analysis. If you can just justify why removing a strip reduces the donor area then I am sold. To me, the only way that a strip could reduce the donor area without reducing density would be, if it lifts the hairline perimeter, ie it pulls the whole scalp up raising the nape etc.


#20

» That was a great analysis. If you can just justify why removing a strip
» reduces the donor area then I am sold. To me, the only way that a strip
» could reduce the donor area without reducing density would be, if it lifts
» the hairline perimeter, ie it pulls the whole scalp up raising the nape
» etc.

As I said it is all terminology.

The true definition of density is mass per unit volume. In the case of hair transplants it is follicular units per cm2.

Strip surgery does raise the scalp up and lift the hairline perimeter but it is so marginal - the elasticity of the skin off sets this amount so it is almost indiscernible. If you have a piece of material 10 cm x 10 cm = 100 cm2 and you remove 1 cm x 10 cm right from the middle of it and stitch it together, the area is now 90 cm2 - in strip surgery, you remove a strip of a given dimension and “sow” the skin together. The difference between our material analogy and human tissue is that the human tissue has elasticity and stretches thus making (within reason) the area of the remaining donor appear to be the same.

Look at an extreme example - if you have a donor area of 20cm x 6 cm. If you remove this entire amount then you have nothing left and insufficient elasticity to cover this area. You have removed 20 x 6 = 120cm2 of tissue. Your donor has completely gone so you have “reduced” your donor region to nothing.

Now, work back, if you remove a 20 cm x 2 cm strip (within the confines of your elasticity), you have removed 40 cm2 of harvestable donor tissue which means that you have only 80 cm2 of donor area left but in the surrounding donor area the FUs per cm2 are unaltered (this again is within the confines of your scalp laxity so that the strip area has effectively disappeared) so the density has not changed in your donor - the mass per unit volume if you will is still our arbitrary 80 FUs cm2 (of what is NOW available), you just have less of them available in total. Before the surgery you had 120cm2 of donor available but now you only have 80cm2 of tissue available but this tissue is still at a rate of 80 FU per cm2 so the density is still the same.

In a nutshell – I have a big head, you have a smaller head. My scalp donor is 120 cm2 at a density of 80 FUs per cm2. Your donor is 80 cm2 at a density of 80 FUs per cm2. Our density is the same. I remove a strip of 20 cm x 2cm which is in the confines of my laxity. My scalp donor tissue is now 80 cm2 because the 20 cm x 2 cm (40cm2) has effectively disappeared – it has been removed. But…… I still have 80 FU per cm2 in my remaining 80 cm2 of scalp donor – my density is still the same as yours. I just have less total donor tissue available.

The trouble with strip though is that scalp laxity will not allow you to harvest the area in its entirety. FUE in isolation on the other hand will not allow you to harvest as many grafts due to reducing the total density. I.e. from 80 FUs cm2 to say 60 cm2.

Based on the numbers a combination of BOTH strip and FUE will produce the highest numbers but as I said, it is not the whole story. With any strip surgery you lose the option to shave your head if the worse comes to the worse.

My maths in my previous post does not take into account other harvestable scalp donor areas where only FUE can go. I argue that you can effectively FUE a “strip” from the lowest part of your available donor area i.e. “over harvest” this area this is either tapered with a haircut or even concealed with longer hair above it.

The nape area (which does not recede on most, I have been looking into this) would in my case also give me over 2600 grafts – strip could not go there.

Individual physiology will also play a HUGE part on what will yield the most grafts too. If you have zero laxity then strip is completely not an option. If you want options (like I do) strip is definitely not the way to go. Strip will not allow you to do the less is more look. A very thin scar is never guaranteed either despite what is inferred by the top docs.

It would be nice if one of the doctors who is very experienced in both strip and FUE would look into this on the “average” patient with solid numbers. My numbers are just speculation.

I think the biggest problem at the present is uninformed patients – I think you need a “solid” plan. You plan will dictate which method is best for you.

Maxwell.