Sausage, Spex isn't saying FUE is bad. He's merely pointing out the pros and cons of both and trying to keep your expectations in check which is vitally important for a prospective HT patient. It still stands that usually if you're going to need a lot of hair then FUT maximises numbers and yield.
I can attest to the fact that shaving right down on transplanted hair looks a little strange as the hair coming out of the scalp looks very coarse but spread very widely apart. It looks a little odd. I reckon it needs to be a least 1cm before it can taper down a bit thinner but you'd need your hair much longer to maximise the shingling effect.
I've only for sure seen 2 transplants in the flesh. One on a guy I played football with who was late 20s early 30s because I could make out the strip scar when he went a little too short on the back (maybe it was a 3) and Joe Rogan the UFC commentator who had work done ages ago. I didn't know it at the time but only found out later when he said on his podcast that it was the dumbest thing he ever did. Seeing as how he has the scar now I don't see why he doesn't go for a big session with H&W, Dr. Rahal or Dr. Feller. It would help him out greatly because he keeps mentioning his hair lately so it's clearly bothering him. His hair is not in a good state. If he did it he would let everyone know because he's a really open and outgoing down to earth celeb. Once he's stripped out he could do some FUE into the scar and even supplement the top with another 1500-2000 FUE. Hope he finds a solution one way or another.
To clarify - rather than have my words twisted any further in reference to my comments here and the other day which were in context of the subject. This guy seems to want to take my words out of context for some reason..Maybe its cause he simply is very confused..
I was referring to shaving all your hair down to the bone in your topic after a HT and informed that this is not a recommended or an advisable approach if the aim is to get a HT and invest 10, 000 's of £ only to only then shave it all off very short or to the bone.The fact of the matter IS a HT needs length to do its job and create the 'illusion' so having a HT and shaving it all off is absolutely pointless in my honest opinion as there WILL be scaring with any type of surgery. Be aware.
In relation to the other topic started by Topcat, i simply was clarifying what was meant by his post as with FUE surgery when performed correctly and extractions form a relatively small surgery are distributed appropriately hair in the donor region in fact can be worn short on a grade 1 0r 2 for example as shown. However there is scaring! FACT. This was from only 1500 FUE. You cant just keep going in again and again without clear evidence especially on this grade after surgery.
Your confusion possibly is the fact FUE patients can wear the donor hair short on a grade 1 and 2 and some even shorter when appropriate surgery and size surgeries are performed but be aware scaring will still reside, its there. How visible the scaring is depends on numerous factors.
A HT shaved down in the recipient area on a grade 1 or 2 can look unnatural in my honest opinion ( all depends on the individual, all their variables and their HT design and approach) and most definitely when a patient shaves his head to the bone after any surgery which is what i ACTUALLY said if you read my comments. If you want that risk, you take it but at least you are now informed.
FUE causes scaring. It does, its surgery. Can you wear your hair shorter with FUE than strip, YES. ( generally speaking) Can you wear your hair to the bone after multiple FUE surgeries NO, in my opinion. If your goal is to have multiple surgeries via FUE and shave all your hair off, pointless in my opinion and THAT was the point i was making in your topic.
I think you need to see patients in person who have had EXACTLY what is is you are aiming to achieve.
Might i ask:
1. How old are you?
2. What NW level are you?
3. Please can you upload pics of recipient and donor region?
4. Are you on medication to prevent further loss?
5.How long have you been researching HT's?
6. How many HT's have you seen in person live in the flesh ?
I am not a doctor or medical professional and my words should not be taken as medical advice. All opinions expressed are my own unless stated otherwise. Always consult with your own family doctor prior to embarking on any form of hair loss treatment or surgery.
I do suggest that you put some pictures up on here as it is very difficult to make any judgements regarding your hairloss without any pictures.
Ideally, you need to have a consultation with at least five of the best surgeons, and preferably face to face with a couple.
No hairtransplant surgery has a 100% success rate with FUE or FUT.
Even the very best surgeons have a small minority of unsatisfied customers which is expected, as this is surgery and any form of surgery there is a risk,that
is why you sign a consent form before.
But the very best surgeons have far, far fewer of these cases.
Spex is not anti-fue.
You do realise that the best surgeons all meet together a few times a year and know each other well.
This is one example:
The International Society of Hair Restoration Surgery is an international, non-profit medical association comprised of over 900 physicians specializing in hair loss representing over 60 countries – dedicated to promulgating the highest standards of medical practice and medical ethics. The ISHRS provides continuing education to physicians specializing in hair transplant surgery and gives the public the latest information on medical and surgical treatments for hair loss.
And their mission statement:
To achieve excellence in patient outcomes by promoting member education, international collegiality, research, ethics, and public awareness.
Now Dr Feller for example was one of two surgeons in the USA who was a pioneer in fue.
He has been performing fue longer than the majority, has had some of the very best results for fue and he has trained several of the best surgeons in fue.
He has even developed the tools for the procedure, and a number of the other top surgeons who perform fue use his tools.
Now why would someone who charges 10$ a grafts not encourage Fue, when infact he charges more like 5$ a grafts for fut?
He would make more money if he was pro fuemegasessions.
Himself and many other the other leading surgeons, who all meet regularly, and even perform on patients in workshops together, all state the same answer that fue is better for smaller procedures.
I think it is very hard to disagree with them.
None of the Leading Surgeons in the world perform Mega Fue.
Some such as Hasson and Wong do not perform fue at all and an interview from Jotronic on the hair transplant network states their reasons respectively.
The clinics who do perform mega fue, are the clinics you should not be consulting with.
They are not ethical,do not generate consistent results over a long period of time and do not have the patients best interests at heart.
They will see you as quick buck and generally are leeches.
If you are going to pay a lot of money for a procedure as this is not expensive, I would rather have at 90% chance than a 60% chance of success.
Fut has been around far longer.
I think the first surgery was performed in 1950's or something and gradually over the time, the technique and has evolved, been refined and now at is very best to date.
People see scars from fut performed 20 YEARS ago and think they are like that now.
The scarring for fut is minimal now, like the edge of a card from a pack of cards so very thin.
Fue produces scarring but it is a different form of scarring.
If you shave you head down bald to a 0, you will see both types of scarring.
I have had a failed fue from a poor surgery and the scarring from my strip surgery is better than the fue.
Hair transplants in general are not for very short hair.
They work well because the grafts are placed at the right angles, in the right positions, to give you the illusion of a full head of hair.
It is said that an average male caucasian has 200 hairs per cm squared.
Now a human can lose up to 50 percent of his hair at a certain length, but to the human eye, will look no different.
This is why surgeons can achieve the illusion of density by doing this.
There are occassions where a patient with minimal loss can have more grafts per square cm transplanted as their is very little risk in further hair loss.
It would better to see some pictures of you and also that you consider medication, as hair loss is progressive and medication can halt and even stop further hairloss in some cases.
If you shave your hair very short, you will notice the difference because you cannot achieve the same look as a person with no hairloss with very short hair lengths.
He would have 200 hairs person cm2( for a caucasian) and the transplanted patient would have around 100 hairs per cm2. But as their hair grows to a certain length, visually you cannot tell the difference by the way surgeons has placed the hairs.
If we had an unlimited hair supply, then it is quite possible to restore your hair to its original capacity.
But we don't, thats why companies such as replicell are trying to overcome this hurdle.
I was referring to shaving all your hair down to the bone in your topic after a HT and informed that this is not a recommended or an advisable approach if the aim is to get a HT and invest 10, 000 's of £ only to only then shave it all off very short or to the bone.The fact of the matter IS a HT needs length to do its job and create the 'illusion' so having a HT and shaving it all off is absolutely pointless in my honest opinion as there WILL be scaring with any type of surgery. Be aware.
Well the question that I asked you in my 2nd post was:
"Why? Some people do not want to be a slap-head and like to have their hair short. Why would it be a bad idea for someone that wants short hair to have any type of hair transplant?"
I was asking about people having their hair cut short, not completely shaved to the bone.
So I am not sure why you answered it that way especially when nobody in their right mind is going to have a hair transplant and then shave it to the bone? I don't think any sane person would choose to do such a thing. I am not even sure why you mentioned that?
I understand the whole scarring issue but I would not expect the scarring to show up on a grade 2 or 3 buzzed look unless your hair is pretty thin. I can understand a grade 1 or less possibly being an issue.
Those photos of the patient you uploaded on the other thread where you stood up for FUE with short hair has a grade 0 by the looks of it which is pretty short.
Everyone is born with a set number of follicular units in their donor area. it does not matter if you harvest those follicular units via strip surgery or FUE. The number cannot change. There is nothing magical about strip procedures in their capacity to produce follicular units from thin air.
One can easily remove as many follicular units by FUE as one can remove follicular units by strip surgery. In fact, you can remove more follicular units from FUE than you can by doing strip procedures. In general patients have about 15,500 follicular units in their donor area and you can remove 20 to 25% of these in a single procedure. If you are unlucky and have only 12,000 FU in your donor area, you certainly will not get as many grafts from a single sitting.
Combining FUE and strip procedures is really not a good idea because strips thin the donor area just as FUE procedures tend to thin the donor area. When you have a strip procedure, you need more hair to cover the strip scar (s) so you will limit the number of grafts you can obtain from a FUE when you start with a strip procedure.
Strips alter the direction of hair growth with the first strip and you can never resolve this problem. I don't care how many grafts you put in the scar. The damage is done.
Studies have shown that FUE and strip procedures produce similar yields. FUE does result in more hair per graft. Strips tend to produce more grafts in a single procedure only because the surgery staff dissects the a finite quantity of follicular units into more graft by splitting follicular units into multiple grafts. In fact the correct term for FUT is sub-FUT because the grafts are subunits of follicular units.
The donor area from FUE is as unpredictable as it is with strip surgery. Having said this in a single strip procedure that heals perfectly, i think you have the capacity to produce an optimal donor area appearance. The problem is that you can't predict the appearance of the donor area. If it is not "perfect", then FUE will produce a better aesthetic result. Also as hair loss progresses more and more procedures are required. It is the second and third strips that produce the wide scars. Again, once you have the strip scar, you can never go back so weigh this carefully.
FUE donor įreas can heal flawlessly in appearance, but they can also heal with white dots. With the hair a few millimeters long, the dots are less apparent or hidden. An average strip scar cannot match this potential.
If you are planning to shave your head, just shave it. If you prefer a shaved head and you want a 5 o'clock shadow look, do a trial of FUE and see how your donor heals. If you have good healing, then do more. If not, stop. Also adding Acell into the extraction sites can result in smaller areas of hypo pigmentation and also some follicle regeneration.
If you want the 5 o'clock shadow look, then keep the grafts to 1 and 2 hairs by splitting follicular units. As mentioned, grafts have darker hair and coarser hair so you can see the difference between grafts and your thinning hair. Keeping the grafts small helps to negate this difference. i often do this in crowns where i anticipate future loss because when hair is lost, you loose color first, diameter second, and hairs per FU third. By keeping the grafts predominately single hair grafts, you create the potential for a more natural less is more short hair style appearance.
i don't think grafts will give you the same degree of coverage over years in all people. i think they tend to either loose hair in some grafts over time or they move to an asynchronous shedding that results in less coverage over time.
Oh, i do mega session of FUE every day. i average 2000 grafts a day. i've done over 4000 FUE grafts in a day. Certainly, it is possible and it can be done very well both by myself and the physicians that I've trained over time. The FUE clinics i would stay away from are the ones where the physician does not do the work.
i also agree that no physician can make every patient happy, but good physicians make the overwhelming majority of their patients content.
Over the course of time, I've done my best to improve the quality of work we can do in a short span of time. What I've found is that you can transplant up to 7000 grafts well, but above this, the yield can drop off when done in a single session. In general, a session of 4000 to 5000 is reasonably safe unless the grafts have a high proportion of body hair. When body hair grafts are used, the density should be limited to 20 to 30 grafts per sq cm. Anything above this with body hair can result not only in poor growth from that procedure, but also poor growth going forward.
This was an advanced degree of hair loss (NW6). The result was at 4 mos. He is now at about 10 or 11 mos, but i think the 4 mos result is a good one to show. The grafts were mixed with Acell and the recipient area was treated with Acell and PRP.
The graft count was about 3500 of scalp hair and about 1200 beard hair. The beard hair was placed in the crown or vertex. This was a single session procedure. Anyone who claims that megasession FUE is not possible has not been following my work over the past 10 years.
A procedure of 3500 FUE grafts in my hands corresponds to over 10,000 hairs. it is the equivalent of over 5000 strip grafts. There is no question that I can produce much better coverage with fewer FUE grafts than the overwhelming majority of physicians can achieve with strip harvesting.
Crowns always take more hair to achieve full coverage. Here is the 11 mos vertex result where only beard hair is transplanted. A good beard hair result is 60%. A great beard hair result is 90%. We'll evaluate the yield when he returns to see us from his home in Europe in a couple of months. You can see that he crown has begun to fill in over the past 7 months. Beard hair can grow in rather curly so it is often a good idea to keep beard hair short following a transplant. The total area of loss in the vertex is significantly reduced, but not eliminated. One problem with beard hair is that most of the grafts are single hair grafts so the overall coverage is less. Another problem is that higher densities can result in less coverage so i prefer to keep the grafts count and density lower in the body hair area. The scalp hair placed in the front resolved this area of hair loss in a single pass. We'll do another pass of beard hair in the vertex and hopefully reach a state of acceptance for the patient.
Regardless, he has very good coverage from a NW6 in a single pass using FUE and he has no strip scar or the resoling distortion in hair growth angles that goes hand in hand with strip surgery. That is not to say the strip surgery is not acceptable for many patients. It's just not right for all patients and I don't think that strips in the best of hands can match FUE in the best of hands in terms of total hair counts.
It's great to read your thoughts/opinions, especially on the comparison of FUE to strip. I was wondering if you could answer a question i have in regards to FUE.
I recently had my first HT, which was an FUE transplant of 1,250 grafts to my hairline. In the first month, the transplanted hairs grew and fell out, as expected. From my understanding, the fact that the transplanted hairs were growing immediately post op, meant that they were healthy and were placed properly.
However, from months 3-9, the vast majority (> 80%) of my transplanted hairs re-grew on my hairline and then fell out again. I've attached a picture of a transplanted hair that grew on my hairline and just fell dead on my scalp. I took it with a USB scope. After talking to a few surgeons/representatives, i believe this has happened due to damage of the follicle during surgery, either during removal, handling or placement.
I never realised a damaged follicle extracted via FUE could produce a damaged hair. I thought a damaged follicle would produce NO hair. Have you come across this before ? I'm almost 12 months post op, with very very poor growth (~ 10 - 15%).
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Originally Posted by Spex
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