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Which Technique First FUE & FUT hair transplant technique


#1

(For the sake of this topic we assume that both techniques are performed competently)

Deciding on a HT is a hard decision; the technique used will play a major factor in your long term happiness, goals and intentions. Both techniques have their pluses and negatives and so it is important to ensure you choose the correct technique for long term planning and getting the most out of your donor.

FUE, the donor surface area is opened to the maximum but that does not mean there are more follicular units (FU) to be taken in comparison to FUT. Every FU removed will reduce the density, the more removed can noticeably drop the density and impair the donor for future procedures, FUE or FUT. Assuming an average density around the safe zone of 80 FU cm2 if the extraction pattern is spread and no areas are over harvested around 4000 FU could be removed, this will drop the overall density down by around 30%, leaving a density near 60 FUcm2 in the donor, and this would then be considered low density on a virgin scalp.

To sustain the density in the donor FUE is better suited to lower graft numbers, with an educated extraction pattern, no over harvesting or partial shaving , then the density change to the scalp can be minimal, if the candidate has an average to good density to start with then around 1500 grafts can be removed and hardly affect the overall density. With more advanced patterns of baldness FUE starts to be less of an option over one or multiple procedures; grown out results of 3500 FUE plus grafts are not the norm and require very good donor characteristics. If high FUE numbers are performed in one procedure there is a greater risk the yield will not mirror that attained through FUT; a real medical concern of large FUE procedure is the effect on the body to heal multiple open wounds created in the recipient and donor area simultaneously and how effective the body can sustain and heal whilst not impairing the scar healing in the donor and yield in the recipient.

A possible exception to the FUE rule on larger hair loss pattern candidates is when there are limited goals, not looking for total restoration, lower density placement due to specific hair styling, or the “5 o’clock shadow” look for those who want a high conservative hair line to frame the face and frontal area and intend to keep their hair short/shaved; but this is not the normal HT candidate and very important that goals and long term intentions are discussed and understood by the candidate and the doctor.

FUT will remove a hair bearing strip of tissue and therefore effectively the hair density has not changed significantly in the donor as the surface area is removed opposed to hairs removed from the surface area. The scalp laxity allows for a strip to be removed without causing any long term tension and over time the skin heals well. There are limits to how many times this can be repeated but in good conditions 2-3 times and with good skin healing attributes it will be able to englobe the existing linear scars to leave a single line rather than multiple wounds.

FUT removes a high concentrated number of FU from a relatively small area and they are removed still in their natural state of high density on the strip; 4000 grafts in one procedure is an achievable number in the majority of candidates unless the donor density or laxity is particularly weak. For long term planning and high NW stages FUT makes it easier to plan and cover with a good density the largest surface area possible. FUT does have the disadvantage of leaving a linear scar so more visible signs a surgical procedure has been carried out but the advantage of being able to move a greater number of FU either in one procedure or multiple procedures compared to FUE and still sustain a similar density as before in the donor.

Conclusion, the advent of FUE means no need to be left with a linear scar for a relatively small amount of grafts placed so from a cosmetic angle it allows the patient to have an HT with little to no obvious signs that a HT has been performed. FUE due to the technical demands of the procedure being labour and time intensive as well as the medical healing and yield concerns is better suited to smaller sessions for the majority of hair loss sufferers. If the pattern of baldness is high and the goal is to cover a large surface area with a natural looking density then FUT would be the sensible and obvious choice to achieve the best result for the candidate.

The combination of both techniques can be utilised to ensure the original scar quality healing is maintained and using FUE to maximise the donor extraction zone, whilst still allowing the potential for future surgery using both techniques if need be. Combining the two techniques allows the best attributes of both to be used, maximum movement of grafts and opens the donor zone, concentrated high number of grafts from FUT and harvesting outside the traditional safe zone with FUE. What has to be remembered though is with either technique they are both scalp/hair characteristic changing in their own way, hair is being removed and there will always be a consequence to this, be it loss of density or laxity or scarring.


#2

Donor supply is king. The only way to maximize donor supply is to do strip and then followed by fue. There s no other way around that.


#3

It just goes to show that neither fue or fut is perfect and even using both can’t always solve the problem for everyone. This is why we need to perfect body hair transplant or better yet come up with something that really truly works for everyone.


#4

» (For the sake of this topic we assume that both techniques are performed
» competently)

I don’t think you can assume away the problem inherent with strip. That a doctor performs strip competently and correctly doesn’t mean that inherent problems with the technique will disappear automatically. The trauma to the donor, widening of the strip scar, higher risk of donor complications just to name a few, whether the doctor performs the surgery competently or not these risks will always be there.


#5

I agree with all the points raised. The good thing is that forum posters have brought them up on their own. This ensures an awareness level where con artists will not be able to dupe NW 6 people believing they need only 1000 grafts to get a full head of hair. (As long as they do their research on the forum).

Regards,
Dr. A


#6

Thanks for the comments and the insight you have all given.

I wrote the post to debate the 2 good techniques because too many people argue about one or the other as if they are the same.

For those who have read my website they will know I am one of the fortunate guys to get more than is normal from FUE, so not the ideal role model perhaps. However I got what was available to me.

Would I have gone Strip if that was all available? Yes possibly, but for the right candidate options are available. Just make sure you do your research and ask questions before committing yourself.


#7

You shouldn’t ignore body hair, I think body hair is under utilised and people are wasting precious scalp donor too casually.


#8

» You shouldn’t ignore body hair, I think body hair is under utilised and
» people are wasting precious scalp donor too casually.

u made a good point i agree 100% but too bad body hair transplant is becoming a dying art.


#9

Body Hair under the right circumstances can be good, as indeed I have had it used in my scalp and to good effect so far.

It isn’t one size fits all though as I am aware of others elsewhere who have been disappointed with the results, be it growth rate or the ability for it to blend with the scalp hair due to textural or characteristic differences in the body hair.

It certainly can however be useful in repair cases and I have seen it take into scar tissue also.

One thing to remember is that if the patient is on DHT blockers then they might not be able to use body hair for the transplant, as sadly the same DHT that causes hair loss in the scalp is used in body hair production. Body/beard hair can certainly diminish if DHT blockers are used.


#10

» » You shouldn’t ignore body hair, I think body hair is under utilised and
» » people are wasting precious scalp donor too casually.
»
» u made a good point i agree 100% but too bad body hair transplant is
» becoming a dying art.

A dying art indeed. It’s just Arvind, Woods and Umar, the 3 musketeers.


#11

I haven’t posted in a long time. I’m 57 and originally had 4 large sessions including a scalp reduction with Bosley Medical Group in Beverly Hills CA back in the late 70’s and early 80’s. Genetically, I would be a Norwood 6 or 7 today. The old 4mm punch graft method should have been illegal in my opinion. I believe the reason it was not is because the overseeing medical authorities never got a grip on the terms “objectivity” and “subjectivity” as it should apply to cosmetic surgery. Objectively, 4mm punch graft work never looked natural. That should have immediately disqualified this type of hair restoration as a legal “remedy” for those suffering from hair loss. Money talks and revenue brings in tax dollars . Ethics lost.
In 2005, I heard about Dr. Woods and Dr. Cole using body hair. My donor area was so depleted and scarred by what Bosley Medical Group did to me that I was very encouraged to think I could one day be comfortable in public without a hat. When I was in my 20’s, I had donor density characteristics way above normal. This may not be the case for all men, but I would say that by age 57 I have less than half the donor density I had in my 20’s. This of course caused my old plug transplant to thin considerably on top. I cringe when I see aggressive hairlines and 8000+ grafts taken from men in their 20’s and 30’s.
In 2005, I was surprised by the controversey regarding body hair transplantation in the forums. I was informed at Dr. Cole’s office way before my first surgery that body hair is a last resort, and the results are not as predictable and coverage is generally not as good as with scalp hair. Here I am in 2009. The body hair is still growing and seems to get denser with time. I have no visible scars on my legs, back and stomach where the grafts were taken, and my only regret is that I ever had Bosley Medical Group do any work on me. I’m still very bald in the back, but that’s because I had very few grafts placed there.
Body hair has worked well for me in blending the “plug” look on my hairline. People don’t stare at my hairline anymore. Fortunately for me the white 4mm donor scarring isn’t raised. The punch graft areas are just white in color. When body hair is grafted into these scars, they become difficult to see and even the skin color seems to improve.
My goal is to more aggressively attack the back of my head and get most of the shotgun scars filled in.


#12

» I haven’t posted in a long time. I’m 57 and originally had 4 large sessions
» including a scalp reduction with Bosley Medical Group in Beverly Hills CA
» back in the late 70’s and early 80’s. Genetically, I would be a Norwood 6
» or 7 today. The old 4mm punch graft method should have been illegal in my
» opinion. I believe the reason it was not is because the overseeing medical
» authorities never got a grip on the terms “objectivity” and “subjectivity”
» as it should apply to cosmetic surgery. Objectively, 4mm punch graft work
» never looked natural. That should have immediately disqualified this type
» of hair restoration as a legal “remedy” for those suffering from hair loss.
» Money talks and revenue brings in tax dollars . Ethics lost.
» In 2005, I heard about Dr. Woods and Dr. Cole using body hair. My donor
» area was so depleted and scarred by what Bosley Medical Group did to me
» that I was very encouraged to think I could one day be comfortable in
» public without a hat. When I was in my 20’s, I had donor density
» characteristics way above normal. This may not be the case for all men, but
» I would say that by age 57 I have less than half the donor density I had in
» my 20’s. This of course caused my old plug transplant to thin considerably
» on top. I cringe when I see aggressive hairlines and 8000+ grafts taken
» from men in their 20’s and 30’s.
» In 2005, I was surprised by the controversey regarding body hair
» transplantation in the forums. I was informed at Dr. Cole’s office way
» before my first surgery that body hair is a last resort, and the results
» are not as predictable and coverage is generally not as good as with scalp
» hair. Here I am in 2009. The body hair is still growing and seems to get
» denser with time. I have no visible scars on my legs, back and stomach
» where the grafts were taken, and my only regret is that I ever had Bosley
» Medical Group do any work on me. I’m still very bald in the back, but
» that’s because I had very few grafts placed there.
» Body hair has worked well for me in blending the “plug” look on my
» hairline. People don’t stare at my hairline anymore. Fortunately for me the
» white 4mm donor scarring isn’t raised. The punch graft areas are just white
» in color. When body hair is grafted into these scars, they become difficult
» to see and even the skin color seems to improve.
» My goal is to more aggressively attack the back of my head and get most of
» the shotgun scars filled in.

Sorry to hear that, it sounds like you have spent half your life battling this. You said you did body hair in 2005 and now you are still a work in progress. Why didn’t you do anything between 2005 and 2009? Anything that prevents you from getting more body hair since 2005 or Dr. Cole advised you to wait that many years before getting more body hair?


#13

NeverAgain Wrote:

“You said you did body hair in 2005 and now you are still a work in progress. Why didn’t you do anything between 2005 and 2009? Anything that prevents you from getting more body hair since 2005 or Dr. Cole advised you to wait that many years before getting more body hair?”

December of 2005 was the beginning of my repair. I have had 4 sessions since 2005. I believe the last was in November 2007. I am overdue, and haven’t been back to Dr. Cole’s office because my work has been non-stop.


#14

» NeverAgain Wrote:
»
» “You said you did body hair in 2005 and now you are still a work in
» progress. Why didn’t you do anything between 2005 and 2009? Anything that
» prevents you from getting more body hair since 2005 or Dr. Cole advised you
» to wait that many years before getting more body hair?”
»
» December of 2005 was the beginning of my repair. I have had 4 sessions
» since 2005. I believe the last was in November 2007. I am overdue, and
» haven’t been back to Dr. Cole’s office because my work has been non-stop.

Hey nthmainneighbor, did Dr. Cole try beard hairs on you? I am thinking of using beard hairs to fix my strip scars. I want to get more feedback how well this really works. I know Umar has some success doing that.


#15

NTH, are you using Propecia or Avodart? I just found out from Dr. Arvind’s thread that Propecia can diminish body hair growth. You would be a good person to ask since you have good body hair growth.


#16

It is common that using DHT inhibitors can have a detrimental effect on body hair HT.

My body hair grew but I found the beard hair transplants I’ve had certainly produced a faster and better yield, the first beard hair was only around 200 grafts and hardly any fell from day 1. The second is growing out now so a few more months before definitive results.

Dr. Bisanga has performed a few beard hair ops now and finds the yield to be good and generally stronger than general body hair. I’ve also noticed with my beard hair that initally the hair was coarser than the native surrounding hair but slowly it is softening up to blend well.

I’ll post some pictures soon of the growth and beard healing.

It’s a good point that I did not mention in the thread, that body/beard hair could be put into the equation, obviously tests should be performed as the yield can vary, although beard hair seems a lot more consistant. But for example in my situation and high initial donor density, FUE couldn’t give me the total coverage I wanted and beard hair is doing well to cover the remaining area for me.


#17

Strip being part of the equation may sound logical for the reason stated above but I saw someone at the mall earlier today and I am sure he would not be agreeing with this. Seeing how old he looked, I would think he had a strip done 6 to 8 years ago when he probably had a much better donor hair density. Today he is a Norwood 7 and his strip scar can be seen very very easily! He has no hope of ever being repaired unless he can FUE some body hair into his donor area.

Yesterday, at work, I spotted someone who had a strip scar that was clearly visible. Strangely, his donor area wasn’t thinned out nor was his hair cut very short but that strip scar still showed thru. Again, I don’t see this person agreeing with strip being part of the equation.

I am reading so many people in these forums going back to REPAIR their scars. I am reading many who wished they never had a strip.

Yes, some may say there are candidates for strip but this equation isn’t as simple nor as clear as it may appear.


#18

I think if both procedures are performed correctly FUE’s benefits outweight strip benefits by far.The dilemma in my opinion is only applicable on people who have the laxity for a strip megasession of 4000 grafts plus.

For people that dont have the laxity for these numbers i dont think there is a real dilemma, assuming that you go to a great doctor that knows what he is doing with FUE and really pays attention to the procedure and its details.

There is poor growth from strip and there is poor growth from FUE, it can happen, the advantage is that if all things go wrong then you can get away more easily with FUE.But you dont go out totally unharmed there will be scarring of some short in both cases.ITs just that small dots are better than smiley scars even if they are very thin.


#19

Q:
"Hey nthmainneighbor, did Dr. Cole try beard hairs on you? I am thinking of using beard hairs."
I’m an older guy. Most of my beard is white which I think (perhaps not a reality) are difficult to extract and provides less appearance of coverage than dark hairs. On the other hand I have a lot of black BH that is coarse and has already worked well in hiding some of the more obvious donor scars.
Q:
"NTH, are you using Propecia or Avodart? I just found out from Dr. Arvind’s thread that Propecia can diminish body hair growth."
I don’t use Propecia or Avodart.
Also, I’ve noticed a lot of guys “baby” their hair. A young guy I work with, for instance fears losing his hair and never washes his hair with shampoo. He barely uses a towel and never uses a comb.
On the other hand, I massage my scalp after I take a shower and rub in Oil of Olay Complete on the top to eliminate dryness and Rogaine on the sides. I don’t use Rogaine on the top because the BH gets individually too coarse and looks more natural if I just leave it alone.


#20

The strip and FUE combination may seem “intuitive” or “logical” at first, but please consider the following in the context of a (hypothetical?) “best practise” all FUE vs FUT/FUE combination;

  1. Donor hair thins with time therby exposing the strip scar more easily
  2. Drugs such as fin/dut may become ineffective or intolerable after several years and with a strip scar, the options narrow
  3. The strip incision itself, on the average mega srtip patient will create a linear line over a foot long (which will appear half as long when sealed)- all along this track, there will be casualties either side of the inscision
  4. Within the strip itself, hair follicles in resting phase ( what percentage I don’t know, but it is not insignificant) are unrecognizable even under microscopes and will probably end up in the nearest bin
  5. A long strip scar, no matter how tidy and thin, is instantly an HT give away to those in the know, and those in the know are increasing day-by-day

BTW, not an Armani shill, wouldn’t go near them, just wanna warn youngsters about being tempted into the “combination route”. Furthermore, I don’t know where a "first class " or “best practise FUE clinic exists” or even if it does, go figure.