FUE verses Strip Harvesting

[gillenator]

Originally Posted by Dr James DeYarman

Still-Researching
Thanks for your questions, I hope these answers help.
If you are treating a NW3 you should be able to do this with 2500 grafts or even less. This amount taken from your donor area should not create a moth eaten appearance. If you hair color is blond or light blond then it even better for you.
From the amount of hair loss you are predicting there should not be a problem with your donor supply.
In reference to your question on HM it is most likely closer to 15 years away then 5.

I agree that 2500 grafts taken by FUE should not leve a moth-eaten appearance at "present" for most patients. IMHO, the real issue or question is "planning over the long term". How many grafts might this patient need in their lifetime based on hairloss classes in their respective family histories?

I find that most men who are suffering from MPB will need way in excess of 2500 grafts over their lifetimes and that's men who are using Propecia.

In 31 years of following this field, I know of very few men who could get by with one procedure once they started HT surgery. I know Dr. DeYarman is not implying this is the case yet the reality of multiple HT surgeries for most men is imminent unless HM/cloning becomes a reality. I further agree that it is far more than 5 years off. Let's hope we are wrong.

Anyway, for those men who do not have advanced classes of hairloss in their family histories, possibly they can get by with FUE and still wear their hair short. But I find they are in the minority, not the majority.

So whether the patient chooses strip or FUE, the potential of buzz cutting styles is not very viable once HT surgery starts, again considering more surgery will be needed in the future. And quite possibly this is one of the trade-offs of losing hair and then getting it back. To have hair in the frontal zone may mean we will not be able to wear short hair, period. At least until some other method of providing donor comes along.

Something to consider in the overall decision.

[Dr James DeYarman]

Gillenator
Thanks for your input, you always give good advice.
I have to correct an earlier post and this is in reference to the number of hairs on the head. The human head has around 100,000 hairs or around 50,000 follicular units. In the worst case you would have from as little as 4000 to as many as 6000 grafts for transplanting. If you did not lose 75% of your hair then you would have more but as Gillenator stated the younger you are when you start losing your hair the more you will most likely lose. I think another thing to consider is if you have a large area of hairloss you should consider a strip for donor harvesting.

[Follicle Death Row]

If as Dr. Cole believes the numbers by FUE are comparable to FUT, FUE yield improves (I think it probably is improving) and you have the financial means I don't see why people would go down the FUT route at this stage. Sure the session sizes are smaller by FUE but that would be a small price to pay I think.

There's a lot of guys on this forum in their mid 20s. Some are too young for HT now and would be best served to wait until 30. If they really are going to take the plunge then surely given how technology progresses they'd have to avoid the FUT scar and go with FUE. For those that are say 25 and should wait until 30 anyway then they may have some fantastic options in 5-10 years.

A 25 year old now suffering from hairloss would in my opinion be a sucker to take the plunge now and undergo FUT. When that 25 year old is 35 and HM is on the market he's going to regret the old smiley on the back of his head. Good things come to those that wait.

We should really push FUE right now as it will be more complementary to future advances. You can always cut down to a 1 and could perhaps add density when HM comes in 10 years or however long it takes. If you have a linear scar well you can never cut your very hair short again.

If we can get 8500ish by FUE, can improve yield to 95% (perhaps Acell can help yield) and have the financial means then it makes little sense to me to go the route of FUT. Sure a FUT+FUE combo can give 10,000 ish over a lifetime but still FUE would have to be the way to go.

Here's a fantastic paper on maximising FUE.

http://www.forhair.com/Articles/Hair...ng.htm#content

A really good FUE doctor should for a norwood 6 be able to get 8000-9000 over 4 or so sessions and a number of years (3 year min I would imagine). But what's more, I may be wrong here and correct me if am, 2000 FUE grafts does not equal 2000 FUT grafts. In FUE, grafts can be cherry picked so I assume it may indeed be possible to transplant more 3 and 4 hair follicles. If this is true then more hair can be tranplaned for the same number of grafts.

If we can get yield up to 95% (Acell mabe?) and can thin the donor to 50% over multiple procedures then FUE is by far the better procedure. Perhaps we're just not quite there yet with yield.

[Locke]

Originally Posted by Follicle Death Row

If as Dr. Cole believes the numbers by FUE are comparable to FUT, FUE yield improves (I think it probably is improving) and you have the financial means I don't see why people would go down the FUT route at this stage. Sure the session sizes are smaller by FUE but that would be a small price to pay I think.

There's a lot of guys on this forum in their mid 20s. Some are too young for HT now and would be best served to wait until 30. If they really are going to take the plunge then surely given how technology progresses they'd have to avoid the FUT scar and go with FUE. For those that are say 25 and should wait until 30 anyway then they may have some fantastic options in 5-10 years.

A 25 year old now suffering from hairloss would in my opinion be a sucker to take the plunge now and undergo FUT. When that 25 year old is 35 and HM is on the market he's going to regret the old smiley on the back of his head. Good things come to those that wait.

We should really push FUE right now as it will be more complementary to future advances. You can always cut down to a 1 and could perhaps add density when HM comes in 10 years or however long it takes. If you have a linear scar well you can never cut your very hair short again.

If we can get 8500ish by FUE, can improve yield to 95% (perhaps Acell can help yield) and have the financial means then it makes little sense to me to go the route of FUT. Sure a FUT+FUE combo can give 10,000 ish over a lifetime but still FUE would have to be the way to go.

Here's a fantastic paper on maximising FUE.

http://www.forhair.com/Articles/Hair...ng.htm#content

A really good FUE doctor should for a norwood 6 be able to get 8000-9000 over 4 or so sessions and a number of years (3 year min I would imagine). But what's more, I may be wrong here and correct me if am, 2000 FUE grafts does not equal 2000 FUT grafts. In FUE, grafts can be cherry picked so I assume it may indeed be possible to transplant more 3 and 4 hair follicles. If this is true then more hair can be tranplaned for the same number of grafts.

If we can get yield up to 95% (Acell mabe?) and can thin the donor to 50% over multiple procedures then FUE is by far the better procedure. Perhaps we're just not quite there yet with yield.

I am 23 and just had an FUT done by Dr. Rahal. Sure I will have the 'smiley' across my head but why would I want to live another 7 years feeling like shit every day when there's is a solution right now? Sure it's not perfect but I think my hair looks fantastic when cut down to a 4 and the scar will be barely visible. If I have no desire to shave my head or shave it below a 4 then really what's the burden of having the scar across my head? Believe what you'd like but I'm incredibly happy with what I've done.

I agree for a 23 year old it would be unwise to commit so many hairs to achieve maximum density if their hairline is barely receeded but for many of us we've lost quite a bit of hair, even more than some 30 and 40 years old on this forum. As long as we commit a realistic amount of hair (60% density) knowing that our hair will continue to fall out and we understand that we will most likely have a bald spot at the crown at the end of it all, then what does the age matter? Things are much more complicated than just saying someone who's in their mid-lower 20's shouldn't have a HT done.

[Follicle Death Row]

Originally Posted by Locke

I am 23 and just had an FUT done by Dr. Rahal. Sure I will have the 'smiley' across my head but why would I want to live another 7 years feeling like shit every day when there's is a solution right now? Sure it's not perfect but I think my hair looks fantastic when cut down to a 4 and the scar will be barely visible. If I have no desire to shave my head or shave it below a 4 then really what's the burden of having the scar across my head? Believe what you'd like but I'm incredibly happy with what I've done.

I agree for a 23 year old it would be unwise to commit so many hairs to achieve maximum density if their hairline is barely receeded but for many of us we've lost quite a bit of hair, even more than some 30 and 40 years old on this forum. As long as we commit a realistic amount of hair (60% density) knowing that our hair will continue to fall out and we understand that we will most likely have a bald spot at the crown at the end of it all, then what does the age matter? Things are much more complicated than just saying someone who's in their mid-lower 20's shouldn't have a HT done.

That's true. I was generalisng with my 25 year old example. I do worry about people transplanting so young though. My own father had a full head of hair until 35. He had no signs of any thinning whatsoever but by 40 he was almost a full norwood 6. So even then you may not know how much hair you're going to lose. Of course all of what I wrote is just my opinion on the matter. The decision to be made is everyone's own. Personally I'll never go for FUT, potentially FUE but ideally neither. I'd be prepared to wait it out for 10 years if I knew HM was on the horizon. I suppose it affects us all a little differently. I'd much rather have my full compliment of hair but FUT doesn't do if for me. I'd always want to be able to cut down on the sides and back to a 1 or 2. That's possible with FUE.

[gillenator]

Originally Posted by Dr James DeYarman

Gillenator
Thanks for your input, you always give good advice.
I have to correct an earlier post and this is in reference to the number of hairs on the head. The human head has around 100,000 hairs or around 50,000 follicular units. In the worst case you would have from as little as 4000 to as many as 6000 grafts for transplanting. If you did not lose 75% of your hair then you would have more but as Gillenator stated the younger you are when you start losing your hair the more you will most likely lose. I think another thing to consider is if you have a large area of hairloss you should consider a strip for donor harvesting.

You are welcome Dr. DeYarman and appreciate your comments and posts on this subject. I readily agree with your numbers and the fact that strip may be the best alternative for patients with large areas of hairloss.

The challenge in counseling the younger men is that they tend to focus on what they want "at present" without considering the fact that MPB is indeed progressive and since more hairloss is in their cards so-to-speak, they need to plan over their lifetimes.

I am seeing more men who started with FUE and are ending up doing strip for those reasons.

[Follicle Death Row]

Originally Posted by gillenator

The challenge in counseling the younger men is that they tend to focus on what they want "at present" without considering the fact that MPB is indeed progressive and since more hairloss is in their cards so-to-speak, they need to plan over their lifetimes.

I am seeing more men who started with FUE and are ending up doing strip for those reasons.

Exactly. It can be slow, expensive and a difficult process to work up to anything like FUT numbers with FUE. If that's even possible due to lower yield and thinning of the donor. It's actually because of the long term outcomes that I probably won't undergo any form of HT. Very risk adverse by nature.

You always give really good sensible advice gillenator. Some young guys don't want to hear it but it has to be said.

[Dr James DeYarman]

Thanks for all your replies, this has been a very good post and will help many people.
I have attach two photos of a 28 year old man that came to my office for consultation. I would like your input reguarding possible transplant. In the front shot are two hairlines drawn in. The front hairline is what the patient wants and the hairline further back is designed for FUE. He is taking Propecia and plans to continue. What are your thoughts?

[Still-Researching]

Great question and thanks for involving us. This is almost getting too personal as my hair loss pattern is almost identical to your candidate. Here are my thoughts, that I am thinking in relations to both him and me, despite I am older (37) and also NW3 and family history of NW3/NW4 maximum:

Questions for the candidate:
What is his line of work, donor density, family history, preferred hair style after surgery etc should be taken into account, as well as could he live with a strip scar?

Facts:
- Hairlines are there for life, so despite being 28, he needs to see this also as his 45-60 year old hairline or older.
- Despite use of propecia, it might stop working in 10 years and he might thin further, he has small evidence of thinning also in the mid scalp/crown area already

My own decisions and recommendations:
Find top doctor (check), FUE, mature hair line that would work for his entire lifetime, natural now and later, reasonable expectations and ready for a worst case scenario for either more surgery in 5-10 years if thinning continues or shave down to clipper 2-3 with nice hairline and some thinning in mid/crown, while still having a nice frame for the face.

So in short I would go for your proposed hairline, which would give him a more symmetric, unbroken and nice framing of his face, even if it is very mature for a 28 year old.

Good luck to the candidate and let us know the outcome - could you send us the picture of the two hairlines in same angle as the first picture of his hair loss.

Looking forward to see other people's recommendations as it would be like giving them to me.

Thanks, again shows the quality of this site.

[gillenator]

Originally Posted by Follicle Death Row

Exactly. It can be slow, expensive and a difficult process to work up to anything like FUT numbers with FUE. If that's even possible due to lower yield and thinning of the donor. It's actually because of the long term outcomes that I probably won't undergo any form of HT. Very risk adverse by nature.

You always give really good sensible advice gillenator. Some young guys don't want to hear it but it has to be said.

Thanks FDR, it's not very often that I hear those words. Some think that I am just a HT salesperson. The truth is that I have seen sooooo many guys over the years just jump into a HT without thinking or researching the risk factors. I have seen way too many lives ruined. Guys that are destined for advanced hairloss classes and do not make good candidates long term. So why get started?

On the other hand, some guys (and women of couse) do in fact make good candiates or candidates for mild restoration. The industry has come a long way over the past 30 years.

My point is that we should never be driven by our emotions but rather step back, take the time to really research both the benefits and risks, and then make an INFORMED DECISION. With proper and adequate research, we all will or should know with time as to whether or not we should be stepping into the OR. And also to know what our complete options are, including non-surgical.

I have said this before and you will hear me say it again, "Surgery should be the last option, not the first".

Thanks again for the kind words my friend...