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  1. #11
    Doctor Representative 35YrsAfter's Avatar
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    Quote Originally Posted by ryan555 View Post
    If you go to a good surgeon you're not going to end up with a terrible scar.
    The reality is, going to a top strip surgeon will minimize the possibility of getting a terrible scar. Dr. Cole has performed over 8,000 strip surgeries and transitioned to FUE in 2002 because some guys, even the best strip candidates get a widened scar even when the surgery proceeds flawlessly. Jetfan11 for example got a widened strip scar and according to a post he made, his scalp laxity was/is excellent.

    The next question is... What constitutes a terrible scar? Here at Dr. Cole's office I see guys in for transplants with long hair that have strip scars 7mm wide. I usually ask them if they would like Dr. Cole to place some grafts into the scar while they're here. Sometimes they say no because they don't care at all about the scar as it's well hidden under the hair. Other times men are traumatized over a 3-4mm wide scar.

    Also, why get a HT if the ultimate goal is to shave your head?
    Good question. On a shaved head, usually both FUE extraction sites and the very best strip scars will become visible to varying degrees. A shaved head shows every little bump and imperfection in crystal clear detail. The best strip scars jump right out at you though. When ACell and PRP are administered, we often but not always see shaved donors that simply have some spaces between the follicular units. No white dots. A wide strip scar will not allow even a modestly short haircut. For instance one man consulted with us because he wanted to lose his hairpiece. His hair on top wasn't overly thin but he couldn't hide his strip scar, so he turned to a piece. This was a reputable doctor and the scar most likely wasn't the doctor's fault. This guy's first surgery resulted in an excellent scar. It was the second strip that created the problem. Multiple strip procedures increase the chance of ending up with widened scars.

    35YrsAfter also posts as CITNews and works at Dr. Cole's office
    Cole Hair Transplant
    1070 Powers Place
    Alpharetta, Georgia 30009
    Phone 678-566-1011
    The contents of my posts are my opinions and not medical advice
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  2. #12
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    Quote Originally Posted by 35YrsAfter View Post
    The reality is, going to a top strip surgeon will minimize the possibility of getting a terrible scar. Dr. Cole has performed over 8,000 strip surgeries and transitioned to FUE in 2002 because some guys, even the best strip candidates get a widened scar even when the surgery proceeds flawlessly. Jetfan11 for example got a widened strip scar and according to a post he made, his scalp laxity was/is excellent.

    The next question is... What constitutes a terrible scar? Here at Dr. Cole's office I see guys in for transplants with long hair that have strip scars 7mm wide. I usually ask them if they would like Dr. Cole to place some grafts into the scar while they're here. Sometimes they say no because they don't care at all about the scar as it's well hidden under the hair. Other times men are traumatized over a 3-4mm wide scar.



    Good question. On a shaved head, usually both FUE extraction sites and the very best strip scars will become visible to varying degrees. A shaved head shows every little bump and imperfection in crystal clear detail. The best strip scars jump right out at you though. When ACell and PRP are administered, we often but not always see shaved donors that simply have some spaces between the follicular units. No white dots. A wide strip scar will not allow even a modestly short haircut. For instance one man consulted with us because he wanted to lose his hairpiece. His hair on top wasn't overly thin but he couldn't hide his strip scar, so he turned to a piece. This was a reputable doctor and the scar most likely wasn't the doctor's fault. This guy's first surgery resulted in an excellent scar. It was the second strip that created the problem. Multiple strip procedures increase the chance of ending up with widened scars.

    35YrsAfter also posts as CITNews and works at Dr. Cole's office
    forhair.com
    Cole Hair Transplant
    1070 Powers Place
    Alpharetta, Georgia 30009
    Phone 678-566-1011
    email 35YrsAfter at chuck@forhair.com
    The contents of my posts are my opinions and not medical advice
    Please feel free to call or email me with any questions. Ask for Chuck
    But which method allows for the most grafts over a lifetime?

  3. #13
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    Also, it's worth noting that you can have a doctor FUE grafts into a strip scar and it can make a huge difference. I had a pretty bad strip scar from a terrible surgeon and Dr Cole put some grafts in there. Now it's hardly noticeable now, even when my hair is really short.

  4. #14
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    Quote Originally Posted by ryan555 View Post
    But which method allows for the most grafts over a lifetime?
    Depends on a lot of things. I once worked with a man in his sixties who had thinning in front and a bald spot in back around 3 1/2" in diameter that was high up. He had thick, consistent caliber donor hair and a "run" of hair in the back area about 5" vertical. He may be a good candidate for strip. But if he were to get a widened scar, he hates enough to have repaired, grafts would be wasted, placed into that scar. Donor grafts are always put to better use in thinning areas on top.

    Hopefully new and more effective treatments will reduce the need for huge numbers of grafts that can adversely impact the appearance of the back and sides of our heads.

    Chuck

  5. #15
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    Quote Originally Posted by 35YrsAfter View Post
    Depends on a lot of things. I once worked with a man in his sixties who had thinning in front and a bald spot in back around 3 1/2" in diameter that was high up. He had thick, consistent caliber donor hair and a "run" of hair in the back area about 5" vertical. He may be a good candidate for strip. But if he were to get a widened scar, he hates enough to have repaired, grafts would be wasted, placed into that scar. Donor grafts are always put to better use in thinning areas on top.

    Hopefully new and more effective treatments will reduce the need for huge numbers of grafts that can adversely impact the appearance of the back and sides of our heads.

    Chuck
    Chuck,

    I appreciate the response but that doesn't really answer the question. I've been told my some great docs - Feller, Shapiro, Bernstein, etc - that one can extract considerably more grafts over one's lifetime via strip than via FUE. It could be a few thousand more by all accounts. I find it odd that all these young guys are so set on FUE when they may end up with a small island of hair at the front of their heads and a slick bald mid section and crown with no grafts left in the bank. Certainly, you could never have achieved some of the transformative results like Spex and Jotronic without using some FUT. Also, to think that one can "deplete" their donor using FUE and then shave their head is naive. Even in the hands of a master like Dr Cole, there is likely to be scarring from FUE that will be noticeable after they've had 4,000+ grafts taken.

    As a guy who jumped into the whole HT thing way prematurely with the attitude "I just want to enjoy my hair while I'm young," I wish to god I could go back and make a more mature decision. These guys who are distraught about their hair loss at 25 are not going to magically stop caring when they're 35 or even 55. We have to live with our decisions forever and planning for the most possible grafts should be at the center of that.

  6. #16
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    Also, there are great new options in dealing with a linear scar, including FUE and SMP. If one could obtain, say, an extra 2,000 or 3,000 grafts via FUT than with FUE and then get SMP to help camouflage the scar, wouldn't that be worth it? Maybe you can only buzz the back to a 3 instead of a 2, but you're getting thousands more grafts in exchange. Isn't that worth it???

  7. #17
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    Quote Originally Posted by ryan555 View Post
    Chuck,

    I appreciate the response but that doesn't really answer the question. I've been told my some great docs - Feller, Shapiro, Bernstein, etc - that one can extract considerably more grafts over one's lifetime via strip than via FUE. It could be a few thousand more by all accounts. I find it odd that all these young guys are so set on FUE when they may end up with a small island of hair at the front of their heads and a slick bald mid section and crown with no grafts left in the bank. Certainly, you could never have achieved some of the transformative results like Spex and Jotronic without using some FUT. Also, to think that one can "deplete" their donor using FUE and then shave their head is naive. Even in the hands of a master like Dr Cole, there is likely to be scarring from FUE that will be noticeable after they've had 4,000+ grafts taken.

    As a guy who jumped into the whole HT thing way prematurely with the attitude "I just want to enjoy my hair while I'm young," I wish to god I could go back and make a more mature decision. These guys who are distraught about their hair loss at 25 are not going to magically stop caring when they're 35 or even 55. We have to live with our decisions forever and planning for the most possible grafts should be at the center of that.
    My thinking on this is, no matter which method is used to remove the hair, if it's 700 grafts or 9,000 grafts, you still have 700, or 9,000 less follicular units in that donor area. ACell and PRP does swing the probability of a fuller donor in favor of FUE. Hopefully those numbers will continue to improve. With strip, there is stretching and the distance between follicular groups increases and the appearance of density of course decreases. I'm not a strip expert, but I know of a debate in a forum some time ago regarding stretching and donor fringe area/height reduction. In other words, a Norwood 6 who has, say 8,000 grafts taken could end up with slightly less "fringe" area/height. I believe that there is more stretching than fringe area shrinking.

    Chuck

  8. #18
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    Both Ryan and 35yearsafter make some valid points.

    I think that beard grafts into scars have lots of potential, and I wish the patients that used beard donor would show their results like NEGuy. We rarely hear back from them...

    The more I research and the more examples that I see both in FUE and FUHT have brought me to the conclusion that competence is essential in both arenas, and more than any other factor is the key to a good result.

    It is not until you have seen enough bad work from each method that one realizes this point.

    Yes, incompetent FUHT work can minimize the future harvest of grafts in the occipital zone because of the width of the scar, damage on either side, and the lower densities. And I still feel very strongly that anyone who desires to buzz their scalp should choose FUE.

    But I have also seen some donor areas harvested by FUE which left so much collateral damage to the neighboring FUs to the point that very little FUs were left to harvest. In those cases just about every one of these men had the work done by someone learning the manual extraction technique. And why would any individual let someone learning FUE do such large sessions on them?

    The real challenge is how does a surgeon learn manual FUE the proper way? They do so by engaging with a competent experienced FUE master in an internship program.

    Actually any form of cosmetic surgery "requires" an internship except the surgical hair restoration field because it is unregulated.
    "Gillenator"
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    NOTE: I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice nor are they the opinions of the following endorsing physicians: Dr. Bob True & Dr. Bob Dorin

  9. #19
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    Chuck what I don’t get about this Acell is that if the product actually did cause hair to regenerate then I would think that the company would pursue that additional indication. Are they pursuing this indication?

    It’s also illegal for the product to be promoted off label so I suppose that is why the company knows not to promote it………….doesn’t mean it can’t be used off label just can’t be promoted. Of course this is for very good reasons.

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