» » Lets make it official. I vote yes. Does anyone second this vote?
» All
» » opinions and comments are very welcome.
»
» I think the question isn’t clear for those who haven’t had ht.
»
» Do you mean that some people are complaining that overall density of the
» hair in the donor area actually goes DOWN after the strip is removed?
»
» Wouldn’t this mean that there is some additional hairloss in the donor
» area, like shock fallout, or a longer term thinning?
»
» Have people observed this?
Hi,
This effect of decreased density is a direct result from the Strip(FUT) procedure. A percentage of hair is destroyed at the moment the doctor makes the incisions to remove the strip. Hundreds to thousands of hairs can be inside of the strip.
Strip is a procedure and can also be referred to as a wedge of skin from the scalp.
Please remember, Density = Follicular units/donor Area, therefore density decreases if any donor area decreases.
»
» This effect of decreased density is a direct result from the Strip(FUT)
» procedure. A percentage of hair is destroyed at the moment the doctor
» makes the incisions to remove the strip. Hundreds to thousands of hairs
» can be inside of the strip.
»
» Strip is a procedure and can also be referred to as a wedge of skin from
» the scalp.
»
» Please remember, Density = Follicular units/donor Area, therefore density
» decreases if any donor area decreases.
Sorry CIT but you need to get your facts right before you post.Its quite obvious that you dont know how far FUT has progressed as well as FUE.
» » Please remember, Density = Follicular units/donor Area, therefore
» density
» » decreases if any donor area decreases.
»
» Sorry CIT but you need to get your facts right before you post.Its quite
» obvious that you dont know how far FUT has progressed as well as FUE.
»
» Please watch this video and learn something.
»
» http://picasaweb.google.com/BobHaber2/HaberSpreader/phot?authkey=IzMfSCmz8uc#5202585668893214434
Good evening bigmac,
You may need to heed your advice. FUT will always involve decreasing the area of the donor area and FUE will always decrease donor density.
FUT will decrease the donor area to make it seem that density is the same at the site of extraction. With strip, the total area of the “safe zone” is decreased. Even with the best “trico closure” result, you may see a very small decrease in donor density but the donor area still remains smaller after the strip of tissue is taken.
FUE will decrease the donor density and will not necessarily decrease the area of the donor area. This is due to the shallow incisions involved with FUE.
Very interesting video but if fails to show the actual strip under magnification. Remember many patients will have a hair density of 200 to 170, and it would be virtually impossible to cut a linear incision in between each of these hairs without destroying a small percentage. Hair grows in many directions and the quantity of hairs on the donor would prevent a double bladed scalpel from destroying at least one follicular unit.
You are welcome to share actual evidence or published data to prove your view to be consistent with the truth. Please refer to the link below for visual aide displaying how density is affected as area is decreased.
» there are a lot of headstrong, tunnel vision guys on here who are SURE that
» density is unaffected by strip procedures
»
» logic and evidence will not persuade them
»
» their “science” is the type on the la la land channel…they
» cannot dispute logical arguments so they invent their own new brand of
» dreamland science
Wow Hanging in there,i`m not saying density is not decreased.
I`ll be checking a few facts out and posting as i dont want to post inaccurate statements about fue.
»
» Good evening bigmac,
»
» You may need to heed your advice. FUT will always involve decreasing the
» area of the donor area and FUE will always decrease donor density.
»
» FUT will decrease the donor area to make it seem that density is the same
» at the site of extraction. With strip, the total area of the “safe zone”
» is decreased. Even with the best “trico closure” result, you may see a
» very small decrease in donor density but the donor area still remains
» smaller after the strip of tissue is taken.
»
»
» FUE will decrease the donor density and will not necessarily decrease the
» area of the donor area. This is due to the shallow incisions involved with
» FUE.
»
»
»
» Very interesting video but if fails to show the actual strip under
» magnification. Remember many patients will have a hair density of 200 to
» 170, and it would be virtually impossible to cut a linear incision in
» between each of these hairs without destroying a small percentage. Hair
» grows in many directions and the quantity of hairs on the donor would
» prevent a double bladed scalpel from destroying at least one follicular
» unit.
»
»
»
» You are welcome to share actual evidence or published data to prove your
» view to be consistent with the truth. Please refer to the link below for
» visual aide displaying how density is affected as area is decreased.
»
Hi CIT
Hope you are well
I will see what i can do to show the strip under magnification as i will have to search about for it.
In the meantime here is something for you.
The fact of the matter is that FUE/CIT also has a level of transections that cannot be accounted for. Peripheral transections that occur in the donor area while the extractions are being performed is never accounted for nor is it ever brought up. Yes you can account for transections of FUE of the grafts that you extract and look under a microscope but YOU CANNOT account for the transections that DO occur within the donor area.
I have read of a single study that tried to account for peripheral transections a.k.a. “The Halo Effect”. And the study said that as the punch size increased, the peripheral transections occurred more. So taking the two transection probabilities into account: The transections you can count under a microscope and the transections that are occurring in the donor are while the extractions are being performed, who knows what the actual transection rate is for FUE. No one ever knows for sure and you certainly have not addressed this."
I do enjoy a good debate with you and trust you will answer the above.
That the scalp is equally stretched over the entire donor area during a strip excision, similar to the balloon analogy, decreasing density per sq cm of hair bearing tissue. This assumes that there is NO excess scalp.
Secondly, that the scalp is not analogous to a balloon. Consider that the scalp may have excess hair bearing skin. visualize a piece of leather with 100,000 hairs that is 5% larger than the skull it covers. A wrinkle if you will. Remove the wrinkle without putting excess tension on the remaining leather. The skull size hasn’t changed, and the leather hasn’t stretched. Do you have less total hair? yes? Do you? Isn’t the removed strip harvested and the hair re-planted? So now you have less leather and the same amount of hair…I digress, let’s keep it simple and get back to my second scenario.
Has the effective donor density decreased? Hmmm. Let’s do the math. Let’s say the leather is 1000 sq centimeters. 100,000/1000= 100 hairs/sq centimeter. Now, remove the excess 5% of hair bearing leather. 1000-5%=950 sq centimeters. Let’s assume the original density remained constant through out the sample. So we removed 5% of the hair as well. 100,000 hairs less 5% is 95,000 divided by the remaining 950 sq. centimeters of leather. Wouldn’t that leave density at 100/sq centimeter?
Let’s review
100,000/1000=100
95,000/950=100
(remember you still have 100,00 hairs-less any transection. But I wanted to keep the math simple for you mathematicians out there. Now what are you going to do when I tell you your overall density actually INCREASED )
equate the area on your skull…that is the area with hair covering it…to a foot ball field
the field size does not change
you go in and remove 10 sq feet of grass…the area left is just dirt
the density of the grass on the area that does not include the dirt…is unchanged
however the area where the grass has been removed…lets equate this to the area in a strip, where the strip has been removed…that area…is still part of the square feet of the football field…and it now has NO GRASS
lets say you could somehow magically stretch or stich the ends of the other grass field area together to cover up the area where the grass was removed…fine…are you still missing the equivalent of 10 square feet of grass on the football field…yes there is no way you can deny this…
there is 10 sq feet of grass…less…grass…on the field than there was before…no matter how you rearrange the grass…the field size remains the same, the 10 sq feet of grass is not there anymore
so how can the density be the same? its impossible
Yes but if the football pitch had an uneven surface with a mound of earth running its length which was covered in grass.Take this mound out and the sides will fold down and meet perfectly and the excess is then redistributed.
» equate the area on your skull…that is the area with hair
» covering it…to a foot ball field
»
» the field size does not change
»
» you go in and remove 10 sq feet of grass…the area left is
» just dirt
»
» the density of the grass on the area that does not include the
» dirt…is unchanged
»
» however the area where the grass has been removed…lets
» equate this to the area in a strip, where the strip has been
» removed…that area…is still part of the square feet of the
» football field…and it now has NO GRASS
»
» lets say you could somehow magically stretch or stich the ends of the
» other grass field area together to cover up the area where the grass was
» removed…fine…are you still missing the
» equivalent of 10 square feet of grass on the football
» field…yes there is no way you can deny
» this…
»
» there is 10 sq feet of grass…less…grass…on the
» field than there was before…no matter how you rearrange the
» grass…the field size remains the same, the 10 sq feet of grass is not
» there anymore
»
» so how can the density be the same? its impossible
O.K. …Let’s use your analogy.
But you must first assume that there is sufficient laxity in the turf to allow removal of the strip of grass, without creating so much tension that the turf will stretch. (or scar). In essence, excess turf.
So now the strip of grass has been removed, without tension or stretching. The now, flatter field is taut. but virtually the same size.
But guess what? you still have the grass from the section that was removed. It gets re-planted into the areas that needed fertilizer… It wasn’t disgarded, only the sod was. Now you have a greener, fuller, field of grass.
Hey guys, not really interested in getting into your strip bashing discussion BUT …
Regarding your formula… “Density = Follicular units/donor Area”
Density is inversely proportional to donor area, thus a decrease in donor area will cause an INCREASE in density (although this is not exactly what occurs in strip). Grade 1 Math, CIT.
» Hey guys, not really interested in getting into your strip bashing
» discussion BUT …
»
» Regarding your formula… “Density = Follicular units/donor Area”
»
»
»
»
» Density is inversely proportional to donor area, thus a decrease in donor
» area will cause an INCREASE in density (although this is not exactly what
» occurs in strip). Grade 1 Math, CIT.
»
» Please continue your strip bashing;-)
Jotronic,
Of course if you repeat the same previously stated formula then you will have made an accurate comment. What exactly occurs is that the number of hairs in the donor area decreases along with decreasing area.
I am clearly stating that the density in the surrounding few centimeters where the strip was taken is less dense than the rest of the donor area that isn’t affected by the strip procedure. The blade also transects hairs, period.
» Hey guys, not really interested in getting into your strip bashing
» discussion BUT …
»
» Regarding your formula… “Density = Follicular units/donor Area”
»
»
»
»
» Density is inversely proportional to donor area, thus a decrease in donor
» area will cause an INCREASE in density (although this is not exactly what
» occurs in strip). Grade 1 Math, CIT.
»
» Please continue your strip bashing;-)
A strip is basically a donor area scalp reduction. The “donor area” (wreath) is SMALLER PERIOD after the surgery. The density might only be slightly less due to stretching, but the nape of the neck is being pulled up towards the back of the head and the top of the scalp is being somewhat streched downwards.
Men who have alot of rolls of extra scalp on the back of their heads/upper necks are much better strip candidates than other men because there is some extra skin there that can be pulled out.
» »
» » Very interesting video but if fails to show the actual strip under
» » magnification. Remember many patients will have a hair density of 200
» to
» » 170, and it would be virtually impossible to cut a linear incision in
» » between each of these hairs without destroying a small percentage.
» Hair
» » grows in many directions and the quantity of hairs on the donor would
» » prevent a double bladed scalpel from destroying at least one follicular
» » unit.
» »
» »
» »
» » You are welcome to share actual evidence or published data to prove
» your
» » view to be consistent with the truth. Please refer to the link below
» for
» » visual aide displaying how density is affected as area is decreased.
» »
» Hi CIT
»
» Hope you are well
»
» I will see what i can do to show the strip under magnification as i will
» have to search about for it.
» In the meantime here is something for you.
»
» The fact of the matter is that FUE/CIT also has a level of transections
» that cannot be accounted for. Peripheral transections that occur in the
» donor area while the extractions are being performed is never accounted for
» nor is it ever brought up. Yes you can account for transections of FUE of
» the grafts that you extract and look under a microscope but YOU CANNOT
» account for the transections that DO occur within the donor area.
»
» I have read of a single study that tried to account for peripheral
» transections a.k.a. “The Halo Effect”. And the study said that as the punch
» size increased, the peripheral transections occurred more. So taking the
» two transection probabilities into account: The transections you can count
» under a microscope and the transections that are occurring in the donor are
» while the extractions are being performed, who knows what the actual
» transection rate is for FUE. No one ever knows for sure and you certainly
» have not addressed this."
»
» I do enjoy a good debate with you and trust you will answer the above.
»
» Cheers Bigmac.
Well CIT are you going to answer my question above about transection rates from fue.
Also if you watch the whole video you will notice how the blade only cuts to a certain depth and not right down to the bulb.Obviously if there is a bulb that is closer to the surface it can be damaged but a couple damaged is a very good result.
Here is the video again to watch. http://picasaweb.google.com/BobHaber2/HaberSpreader/photo?authkey=IzMfSCmz8uc#5202585668893214434
Now again will you answer my questions as i`m very interested in your opinion on transection rates with fue/cit and if you could explain how your punches minimalise transections.
This is a very simple concept, bigmac. If one were to draw a straight line anywhere on the scalp, the chances of hitting a follicle or follicular unit are 100%. If one were to take, say, a .75 mm punch and pick and choose follicular units or follicles for removal, the chances of “hitting” surrounding follicles are quite minimal (maybe 5%, or so). So, mathematically speaking, the chances of damaging nearby follicles in a strip procedure are astronomical, whereas that chances of damaging follicles via FUE are really quite minimal, if not nonexistent.
Please explain the baloney about not going to the depth of the bulb. If that were the case, how in the world would the strip bearing the FU’s be viable?
» » »
» » » Very interesting video but if fails to show the actual strip under
» » » magnification. Remember many patients will have a hair density of
» 200
» » to
» » » 170, and it would be virtually impossible to cut a linear incision in
» » » between each of these hairs without destroying a small percentage.
» » Hair
» » » grows in many directions and the quantity of hairs on the donor would
» » » prevent a double bladed scalpel from destroying at least one
» follicular
» » » unit.
» » »
» » »
» » »
» » » You are welcome to share actual evidence or published data to prove
» » your
» » » view to be consistent with the truth. Please refer to the link below
» » for
» » » visual aide displaying how density is affected as area is decreased.
» » »
» » Hi CIT
» »
» » Hope you are well
» »
» » I will see what i can do to show the strip under magnification as i
» will
» » have to search about for it.
» » In the meantime here is something for you.
» »
» » The fact of the matter is that FUE/CIT also has a level of transections
» » that cannot be accounted for. Peripheral transections that occur in the
» » donor area while the extractions are being performed is never accounted
» for
» » nor is it ever brought up. Yes you can account for transections of FUE
» of
» » the grafts that you extract and look under a microscope but YOU CANNOT
» » account for the transections that DO occur within the donor area.
» »
» » I have read of a single study that tried to account for peripheral
» » transections a.k.a. “The Halo Effect”. And the study said that as the
» punch
» » size increased, the peripheral transections occurred more. So taking
» the
» » two transection probabilities into account: The transections you can
» count
» » under a microscope and the transections that are occurring in the donor
» are
» » while the extractions are being performed, who knows what the actual
» » transection rate is for FUE. No one ever knows for sure and you
» certainly
» » have not addressed this."
» »
» » I do enjoy a good debate with you and trust you will answer the above.
» »
» » Cheers Bigmac.
»
» Well CIT are you going to answer my question above about transection rates
» from fue.
» Also if you watch the whole video you will notice how the blade only cuts
» to a certain depth and not right down to the bulb.Obviously if there is a
» bulb that is closer to the surface it can be damaged but a couple damaged
» is a very good result.
» Here is the video again to watch.
» http://picasaweb.google.com/BobHaber2/HaberSpreader/photo?authkey=IzMfSCmz8uc#5202585668893214434
»
» Now again will you answer my questions as im very interested in your » opinion on transection rates with fue/cit and if you could explain how your » punches minimalise transections. » » Please answer as ive answered you.
Dude,
Popular belief states that strip surgeons should go below the bulb to take some fatty tissue and avoid damaging the strip. I think that the scalpels would transect more than “two” FUs. You may want to check your bologna before you post. That’s Oscar Meyer!
CIT, and the other members have a good point to share.
I am glad you have great input into this debate. Your input is valuable, however CIT’s answers to my direct and very specific questions are needed here. CIT???"
» Dear all,
»
» I am glad you have great input into this debate. Your input is valuable,
» however CIT’s answers to my direct and very specific questions are needed
» here. CIT???"
bigmac,
Our transection rate in currently from 2% to 3% on any given day. Any transection is properly documented and the donor area are examined as FU distribution varies on each patient. Each FUE clinic must represent itself and properly document it’s own data. Every graft is extracted under high magnification and placed under magnification.
This is not to mention that there may be clinic who don’t document the surgery.
Innovation, experience, surgeons’ insight and devices specifically designed for each hair restoration patients’ donor enable preservation of the donor area.
First let me thank you for answering half of the questions asked. However you left out the most important part of the question that no one wishes to answer or address. I do understand that each and every graft must be checked in order to confirm the transections acquired upon extraction as well as to count the numbers per graft. Most clinics that perform FUE have adopted this documentation but what intrigues me more is the fact that sometimes follicular units in the donor area can be damaged by the punch DURING the extraction process. While it might not be a regular occurance, it is more evident in higher density patients that have higher numbers of hairs per graft and a density that is normal to high (very tightly packed follicular units) . The study that I read and quoted in the previous post (from a sponsored clinic on this site), stated that given these conditions, PERIPHERAL TRANSECTIONS IN THE DONOR AREA ARE INEVITABLE, AND INCREASING PUNCH SIZE WILL INCREASE THE PERIPHERAL TRANSECTIONS AKA “THE HALO EFFECT”.
So I ask you once more. How do you account for peripheral transections? Or is this just something that is over looked… which would then even the playing field of the strip vs. FUE transection accountability given perfect conditions for both procedures? In other words… Transection rates for both procedures are virtually similar (3%-10%) taken into account advancements in both procedures and knowing full well that peripheral transections during FUE are real and unaccounted for.
The second part of this debate is really easy when speaking about the strip excision and density changes. I asked the opinion of a well known and accomplished strip surgeon what he thought happened to the density in the donor area when you excise a strip and FUE. It is simple. The OVERALL DENSITY DECREASES… Dah! If you started out with 100 follicular units overall, then take a 25% strip out of the middle, then, what happens?
The overall density decreases by 25% However the density decrease occurs in one area and after the suture of the upper and lower strip, the density decrease is virtually unnoticed… at first… then…
Healing begins and some stretch back can occur, which can potentially pull folicular units apart from one another… ONLY near the strip line. though.
The area right at the strip suture line. If all conditions are perfect, i.e. virgin scalp, good closure, patient follows post op instructions, resulting in a pencil line scar, the decrease in density AROUND THE SCAR (during stretch back) WILL BE LESS THAN 5% WHICH WILL BE NEGLIGIBLE TO THE NAKED EYE. Everywhere else will have the exact density pre-strip.
So there it is. However I asked the doctor one last question, " Doc, What happens to the overall and local density in FUE? He says there is a DIFFUSE DECREASE IN DENSITY. Which is the decrease in density overall and not localized as much as the density decrease around a strip excision suture line.
This makes sense. This doesn’t give any procedure a better outcome in terms of density but IMO does provide more questions, insight and clarity instead of dodging the truth."
» “CIT,
»
» First let me thank you for answering half of the questions asked. However
» you left out the most important part of the question that no one wishes to
» answer or address. I do understand that each and every graft must be
» checked in order to confirm the transections acquired upon extraction as
» well as to count the numbers per graft. Most clinics that perform FUE have
» adopted this documentation but what intrigues me more is the fact that
» sometimes follicular units in the donor area can be damaged by the punch
» DURING the extraction process. While it might not be a regular occurance,
» it is more evident in higher density patients that have higher numbers of
» hairs per graft and a density that is normal to high (very tightly packed
» follicular units) . The study that I read and quoted in the previous post
» (from a sponsored clinic on this site), stated that given these
» conditions, PERIPHERAL TRANSECTIONS IN THE DONOR AREA ARE INEVITABLE, AND
» INCREASING PUNCH SIZE WILL INCREASE THE PERIPHERAL TRANSECTIONS AKA “THE
» HALO EFFECT”.
»
» So I ask you once more. How do you account for peripheral transections? Or
» is this just something that is over looked… which would then even the
» playing field of the strip vs. FUE transection accountability given perfect
» conditions for both procedures? In other words… Transection rates for
» both procedures are virtually similar (3%-10%) taken into account
» advancements in both procedures and knowing full well that peripheral
» transections during FUE are real and unaccounted for.
»
» The second part of this debate is really easy when speaking about the
» strip excision and density changes. I asked the opinion of a well known and
» accomplished strip surgeon what he thought happened to the density in the
» donor area when you excise a strip and FUE. It is simple. The OVERALL
» DENSITY DECREASES… Dah! If you started out with 100 follicular units
» overall, then take a 25% strip out of the middle, then, what happens?
» 1. The overall density decreases by 25% However the density decrease
» occurs in one area and after the suture of the upper and lower strip, the
» density decrease is virtually unnoticed… at first… then…
» 2. Healing begins and some stretch back can occur, which can potentially
» pull folicular units apart from one another… ONLY near the strip line.
» though.
» 3. The area right at the strip suture line. If all conditions are perfect,
» i.e. virgin scalp, good closure, patient follows post op instructions,
» resulting in a pencil line scar, the decrease in density AROUND THE SCAR
» (during stretch back) WILL BE LESS THAN 5% WHICH WILL BE NEGLIGIBLE TO THE
» NAKED EYE. Everywhere else will have the exact density pre-strip.
»
» So there it is. However I asked the doctor one last question, " Doc, What
» happens to the overall and local density in FUE? He says there is a DIFFUSE
» DECREASE IN DENSITY. Which is the decrease in density overall and not
» localized as much as the density decrease around a strip excision suture
» line.
»
» This makes sense. This doesn’t give any procedure a better outcome in
» terms of density but IMO does provide more questions, insight and clarity
» instead of dodging the truth.”
»
» Thanks bigmac.
Bigmac,
You are very welcome. The basic mathematics of one’s donor area can vary based on race. Caucasians usually have a higher hair density and Asians typically have a lower hair density. Each patient is not created equal and no two donors are the same
The majority of patients who have a finer thickness of hair usually have more hairs per follicular unit. Patients who have larger follicular units typically have thicker hairs. The trade off is significant in some cases because the hair follicles may even be wavier.
Our clinic uses small customized devices after careful examination of any given patient’s donor area. You will see from the photo below, the follicle angulations, instrumentation, and magnification account for low transaction.
Peripheral transaction is insignificant as you may notice that follicular units are naturally distributed on the donor area. To ensure that this doesn’t occur, Dr. Cole routinely changes devices during the procedure as follicle may splay in different directions. To compensate for the characteristics, Dr.Cole uses his judgment to determine what instrument will accomplish the best result on the donor area as well as recipient area.
Below is a microscope photo taken of an above average donor that measures a donor density of 250 hairs per square centimeter and 90 follicular units per square centimeter. Please remember that the follicular units naturally grow at a density that allows tolerance for these extremely small geometric instruments to harvest between them. There is no pattern at which the FU are harvested other than being harvested at a low density for preservation of the area. I will have you know that “diffuse decrease in density” is another way of saying that our clinic uses an actual device on the donor area as to not over-harvest any one particular area. I would be enlightened to see the data that shows any peripheral transaction from a given clinic. With the small instruments we use at our clinic, peripheral transaction is non-existent. Every graft is examined before the next process occurs. Once I do find an isolated incident where a surrounding FU was compromised then I will post the recorded data.
In the end, the donor area or donor density will always decrease by any harvesting method. The questions of a lifetime will be which patients will have the unbearable side-effects. What patients will have the luxury of wearing their desired hair style, and what donor resource will be available after the laxity of the donor is non-existent. Each patient must decide if the risks outweigh the benefits.
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