View Full Version : FUT or wait for Histogen etc.?

05-23-2011, 06:01 AM
First I would like to thank you for a great hair loss forum, which has educated me and helped me a lot over the years.

I have never posted here before, but as I am seriously considering taking the hair transplant route now I have some questions I hope you guys will be able to help me with.

I am 29 years old, curently living in Belgium, and have been losing my hair for about 5-6 years. I have been taking propecia, minoxdil (foam once a day) and nizoral for the last 3-4 years and it has somewhat helped stabilizing my hair loss. My current hair loss is a NW3 pattern so it is basically "just" the temples and hairline that is of concern to me.

I have come to a point where I am now sick and tired of trying to style my hair and covering up my bald temples. I am constantly aware of my hairline and I hate windy weather (I guess some of you guys trying to cover your hair loss with the remaining hair can relate to this).

I tried just to buzz my head 4 years ago but unfortunately I don't look good with a buzzed head because of a tall and narrow freaking head which has a kind of "bump" on the crown. Consequently, buzzing my head and forgetting about my hair loss is a bit difficult for me.

I am considering having my hair line reestablished with FUT with Rahal or Shapiro. I have been told that I need approx. 2000-2500 grafts to address my concerns. I really feel that I have been doing my research over the years now and that my expectations are realistic.

The reason why I am considering FUT is mainly because I don't look good with a buzzed head so the FUE doesn't really make sense to me as I would not buzz my head in the future. Consequently, choosing a procedure which limits my donor hair and probably has lower yield than FUT does not seem like the best thing to do.

However, I am scared sh*tless of having a strip removed from my head. I am scared of the fact that even with a great doc you a never really guaranteed a pencil thin scar and high yield. There are so many uncertainties with hair transplantation (even with the best docs). And there are so many uncertainties with hair loss. I am now 29 with a NW3 pattern. Where will I end up? My father has all his hair (a NW1) but my grandfather (my father's side) was a NW6 (the only person in my family with hair loss besides me). This is also why I am considering strip as I don't want to come short of donor hair (mine is above average) if/when I progress further down the NW scale. Going with FUE and coming short of donor hair I would have to buzz my head and reveal my oddly shaped head (which is of cause better than having no yield with FUT and revealing an oddly shaped head and a stretched smiley scar this would be worst case scenario).

With all of the above mentioned concerns I am considering waiting 3-4 years for Histogen, Acell, etc. instead of having FUT procedure now (and scar on the back of my head for the rest of my life). I don't expect e.g. Histogen to restore my hairline completely. If Histogens works (and won't be delayed) I'm thinking of restoring the remaining hairline with FUE (maybe plucking with Acell if it works) at that time - after having seen what amount of hair Histogen may grow on my hairline and temples. FUE would then make more sense to me as I would hopefully not have to worry about coming short of donor hair.

Then again I hate my current hair loss situation. And I would hate to wait another 3-4 years (I truly believe or hope that this is the time frame - I know that we have been informed of "cures" within 5-10 years for 20 years now but I believe the companies are finally on to something - if not a cure then as least something to hold onto until a cure somes out) for a product (Histogen, Acell etc.) that may not even work and then have a FUT procedure anyway.

What do you guys think? Should I go with FUT now (and hope for good yield and a pencil thin scar) or should I wait given my above mentioned concerns?

Thank you so much hearing me out. :)

05-23-2011, 04:48 PM
If I were you and had the money, I'd first start off with PRP+Acell injections. Some people claim that the combination has added density to their hair and even regrown some miniaturized hairs. If it worked for you, it might give you enough density to hold you over until better treatments come along.

Dr. Cole posted this video (http://www.baldtruthtalk.com/showthread.php?t=5169) last week about his experiences with FUE & Acell and in the accompanying article, he claimed that using his extraction technique with Acell resulted in "an overall regrowth of 54%" in the donor area.

As for FUE vs FUT, remember that no procedure is scar-less. While FUT gives you a long scar, FUE results in some spots (hypopigmentation). Of course, these scars are usually only a problem if you keep your hair really short.

Given what you want, if I were you, I'd go for FUE because (if Histogen works) you could refill that donor area (assuming Histogen will work in a harvested, slightly scared donor area). I think the ability of doctors to control Histogen will be limited (I.E. they will be able to keep it in a certain area, but not build a nice, crisp hairline) and it would be good to have that donor back-up.

05-23-2011, 09:59 PM
I'm going to agree with you, Wilymon. Also, those white dots are almost invisible, even if you shave your head. But I wouldn't get my hopes up for Histogen...I personally trust Aderans more...Replicel is also interesting.

Follicle Death Row
05-24-2011, 07:35 PM
I'm 25 and I'd say Norwood 2.5ish and hate my hair. Suppose I probably started to thin at about 21 but never really noticed it and the initial recession to norwood 2 didn't bother me. Bladed it down to a 2 back in March to inspect the damage and it looked horrendous because I could see the miniturisiation in a norwood 6 shape. Perhaps I shouldn't have been so surprised since my father is a norwood 6 but he made it to 34 before he noticed any thinning. A bit harder when it kicks in at 21 but such is life.

Now I don't really know how to advise you on this one. It's a tough one and there's so many variables. If you're married or in a good relationship then I'd say no way in hell should you go for a FUT. I wouldn't do strip myself at 29, single and NW3 but you might feel differently. Sure hair makes a difference to our appearance and self image but I won't get into the psychology of hair loss.

The thing is once you take the plunge and get FUE or FUT there's no turning back and it's a lifelong commitment plus you may not be happy with results 10-15 years down the line. Anyone bound for NW 6 is looking at 8000-9000 FU by strip and 50,000 euros and a lot of stress over the years for an end result that may be rubbish. 250cm2 of baldness when you get into that territory. If all the native hair goes even 9000 may not satisfy you. Sure 9000 is going to look amazing in photos and perfectly normal to onlookers but you might think differently looking in the mirror. They never look as dense in reality.

I personally wouldn't go for it unless I thought I was looking at 200cm2 or less of baldness. I'm white, have straight black hair and I'm heading towards 250cm2 of bald scalp years down the line and know in my heart that 9000 is not going to cut it.

I myself refuse to use finasteride because even if I don't get side effects the whole idea behind it as a solution is plain wrong. I'd rather go bald than be unhappy with a botched job and a ridiculous smiley on the back of my head either. Shaving would no longer be an option. FUE is also out of the question for extensive balding. Only 5000-6000 max by FUE is possible.

The industry promises so much and delivers so little so you can't reliably wait on histogen or aderans getting it done in the next 5 years. Could be 2015, could be 2020 or 2025. Remember we got minox in 88, fin in '98 and nothing in the last 12 years. I've resigned myself to going bald or a better solution coming along than what we currently have.

I'm only going to use minoxidil and nizoral to slow things. I'll probably just shave it all off in a year or two at most if I'm being realistic but for now I'm going to use those 2 to try and bridge to Histogen and/or PRP+Acell and then bridge to Aderans.

I will not undergo FUE or FUT until 13,000 FU becomes a reality. Actually I won't undergo strip at all. 13,000 is the tipping point for me and it's dependent on serious donor regeneration or hair cloning from Aderans.

If Dr. Cole is getting 54% regeneration of donor with Acell you might want to look into that. 13,000 FU over a lifetime would be the limit by FUE if this donor regeneration figure is true and it can be reharvested. That's based on thinning out the donor by 30%. You might want to wait and see if he can take things to the next level. It's reassuring to see that Dr. Cole, Dr. Cooley, Dr. Hitzig and Dr. Bernstein are taking Acell seriously.

I'd advise at least waiting two years if you can. I'll probably be waiting forever or give up in a couple of years. My doc gave me some real honest no bs advice. Told me only 1 in 5 that come to him actually pursue the surgical route. I'm going to wait like the other 80%. The industry is not quite there yet.

By the way if you do go with Dr. Shapiro or Dr. Rahal you will have made a fantastic choice. Rahal does really nice hairline work from what I've seen. You might get 60FU/cm2 in the hairline. They'll certainly give you a real shot at getting a great result.

Very best of luck with whatever you decide.

Follicle Death Row
05-24-2011, 07:41 PM
Oh yeah agree completely with Wilymon. For people in the early stages it's probably a good idea to wait it out for another 2 years to see if PRP+Acell can maintain or reverse somewhat. Also surely we'll know more about Histogen and Aderans. It could act as a bridge to Aderans cloning. We could yet get back a lot of hair and forego the strip scar. You won't lose anything by waiting another few years...except more hair.:(

05-25-2011, 01:49 AM
Thank you for your response guys. I appreciate it! :)

I am really torn here. On one hand I would really like to do something about my hair loss while I am still young. On the other hand I am so scared of ending up with a strip scar less than pencil thin and undetectable even with short hair (approx. 1 cm).

I seriously don't look good with a shaved head so I would really like to avoid this. That is why I am considering FUT and not FUE as I would most likely not shave my head in the future. However, if I progress to a NW6-7 I would like to be able to buzz my hair quite short (approx. 1 cm or less) and this option could be out of the picture if I go with FUT. Hopefully FUE into the FUT scar could somewhat help minimize the linear scar if I choose the FUT procedure.

Fortunately, I have a sweet and beautiful girlfriend I love more than anything in the world, so I don't feel the same pressure of doing something about my hair loss as I would probably do if I were single.

Perhaps I should wait. I mean I have waited for several years now. Waiting perhaps 2 years, just to see if there's any progress with histogen, aderans etc., won't kill me. However, I know that I would rather do something about my hair loss now than ending up waiting 10 years for a new method. I already feel like the best years of my life has been taking away from me as I started receding about 6 years ago. Unfortunately, there is no way of telling how long I would have to wait if I decide to do so.

Follicle Death Row. Thank you for your thorough response. Unfortunately, I can't pull of a completely buzzed head. It has to be at least 1 cm to avoid showing off my oddly shaped head. I hope your head looks good buzz if you decide to take that route. If a had a more normal shaped head and thinned in a NW6 pattern it would definitely be my choice. I would probably also try propecia. It has kind of slowed things down for me. But I hate the fact that I have to take pills for the rest of my freaking life to hold on to my hair. I am the type of guy who don't like to take pills if not strictly necessary so this situation really bothers me, so I totally understand you. Good luck with whatever you decide to do. :)

05-25-2011, 01:50 AM
Any other thoughts about what I should do? :confused:

05-25-2011, 03:40 AM
Well if you are afraid of cutting out a strip (which i can understand) you should ask Cooley, Hitzig or COle or Bernstein if you can participate in their Acell studies for Donor Expansion thats the only advise i can give right now

Follicle Death Row
05-25-2011, 11:22 AM
Well if you are afraid of cutting out a strip (which i can understand) you should ask Cooley, Hitzig or COle or Bernstein if you can participate in their Acell studies for Donor Expansion thats the only advise i can give right now

Yeah they might actually be on to something legitimate this time. If Bernstein is looking at it then it must have some genuine promise. My last bit of advice would be to wait for phase 2 results from Aderans and phase 2 results from Histogen. If they move into phase 3 then I'd wait but if they don't have a runner, then take the plunge. Most drugs don't make it into phase 3 unfortunately. Dr. Cole's work sounds very promising.

05-25-2011, 02:44 PM
Yeah agree just dont do FUT at this point in time it would be nonsense

05-26-2011, 12:27 AM
Thanks for your input guys. I appreciate it.

Actually it would a lot easier to make a decision if we didn't have any promising future procedures like the ones mentioned. Then I would probably just take the plunge and don't look back.

05-26-2011, 01:20 AM
I agree, for me its almost to much of different approaches which in some stupid way seems all very plausible.

My favorite solution would be a total scarless FUE multiplication thing where the donor area completely regrows

05-26-2011, 02:23 AM
Yeah. All of the different approaches are kind of confusing. However, it is nice to have a gun full of bullets as some are probably going to miss the target. Hopefully at least on will hit the target directly. The question is when this is going to happen. :)

Follicle Death Row
05-26-2011, 12:29 PM
It's the paradox of choice. I'm sure the gold standard will improve over the next decade. FUE with partial donor regrowth has to be the the bridge between what we have now and the eventual arrival HM. The problem as it stands now is this; even one suboptimal surgery where yield is poor and those heading towards advanced MPB are screwed. Simply not enough paint to cover an ever expanding canvas. We simply can't expect results like Nic Nitro or London Lad. These are the exceptions. It's still a serious risk.

05-26-2011, 12:46 PM
i would absolutely go for a FUE when i can get a guaranteed 80% or more regrowth rate because this would mean infite donor or in laymen terms

"A NW7 guy could become a dense NW2 again. Thats why i actually wait for the other FUE docs to get regrowth rates.

An 80% regrowth rate at 4000 grafts would be amazing because as a NW7 you need around 7000 Grafts and with 80% regrowth you would EASILY expand that amount of donor hair after the second transplant already because after the first you would have 4000 transplanted and around 3200 regrowth ones.

And the best thing, no more of those strange medication things. With Coles 54% regrowth at 4000 grafts you would get around

etc Grafts harvested which would be around 7500 grafts. And the best thing compared to lets say Gho is, you would see results after the first transplantation at a more reasonable price tag.

My problem with Gho is the price tag and the density of transplants and the session number. I think offering 1900 Grafts at that price tag is just ridiculous at best.

Follicle Death Row
05-26-2011, 01:29 PM
I absolutely agree. FUE with donor regeneration is the future. It's a real phenomenon. Consistency and experience is the key. I actually did the number crunching on this and with the 54% donor regeneration figure we could harvest a norwood 6/7 multiple times. Assuming they have up to 20,000 FU in their horseshoe you could transplant 13,000 over a lifetime and wind up with only thinning out the donor by 30% (14,020 left in the horsehoe).

Let's hope the top FUE doctors can make this happen in the near future. If Cole or Feller could make this 54% a consistent, real in practice figure, it would usher in a new era. People would be going on a biannual basis for Dr. Feller's lunch time FUE. This is what I'm waiting for. Seems more realistic than Aderans hair cloning at this point in time because Dr. Cole seems to have proof of concept. I really hope it can be verified by his peers.

13,000 available by FUE! Could you imagine it. Unreal.

05-26-2011, 03:12 PM
13.000 is around 26.000 hairs and therefore around barely one third of your all time hair which is good in comparison with whats in the donor left. And those numbers are only with around 50% regrowth rate.

I think we all agree that with around 80% we shouldnt even discuss anymore because this problem would be solved. And the best thing is with a smaller extraction tool is, that well it would be more consistent.

I mean come on Cole got as an average around 50% regrowth which is well "good" for a Curiosity test. If he can produce a solid 80% (i take 80% because i just assume we all go NW7 and want a dense (70 density) NW2 head with hair.

And this can be achieved with an 80% regrowth rate. Here i would say its higher likely that you will die before your donor is finally depleted (shocking but true)....ok this whole die thing was a serious downer.

And dont forget even this technique can advance to

1) less time consuming etc

And yes 13.000 is a lot of Grafts (you got around that amount on your crown area).

I hope that all the FUE docs can get this thing done and that they will test this donor regrowth thing with an robotic device, cause to me THIS would be the future we all know from sci fi movies

1) A robotic transplantation device which is capable of transplanting the hairs with a high density and donor regrowth in a shorter amount of time

Follicle Death Row
05-26-2011, 04:15 PM
I really enjoy crunching the numbers and looking at the art of the hair restoration. Let's assume 54% regrowth or higher becomes a reality 3 or 4 years down the line.

I think realistically we could expect a 0.8mm punch tool if want to be able to extract the 2 and 3 FU groupings. Any smaller and we're going into the Gho realm of transection every time. But a 0.8mm diameter punch gives just over 0.5cm2 area to heal as compared to 0.64cm2 for 0.9mm and 0.79cm2 for 1mm punch. Got to go with the 0.8 and Acell for no hypopigmentation.

Assume pre-MPB density 90FU/cm2, Area to cover 275cm2 (Norwood 7ish)

1. Hairline
Area = 35cm2
Density = 70FU/cm2
Total FU = 2450

Ridiculously good density, predominantly ones, can be lower and broader

2. Extended Central Forelock to Midscalp
Area = 35cm2
Density = 60FU/cm2
Total FU = 2100

The area that prevents see through, critically important, 2s & 3s

3. Either side of Forelock to Midscalp
Area = 45cm2
Density = 45 FU/cm2
Total FU = 2025

4. Transition from Mid Scalp to Anterior Crown
Area = 60cm2
Density = 45 FU/cm2
Total FU = 2700

5. Crown
Area = 100cm2
Density = 35 FU/cm2
Total FU = 3500

Total FU = 12,775

Apologies for kind of making up names to areas on the scalp but hopefully you get the idea. This is what could be possible for even the most extreme case.

Follicle Death Row
05-26-2011, 04:18 PM
It will happen eventually whether by FUE alone, strip alone or a combo. Nic Nitro is up near 10,500 with another couple of thousand left. London lad is at like 11,200 with another decent strip left. Neither have tapped into FUE yet so you could probably add another 1000.

05-26-2011, 05:39 PM
I assume you crunch hose numbers for a Worse case scenario, right. Good numbers btw, its good to calculate from a worse case scenario here.

Yes the crown is the Damn factor. Here i would do the following with lets say an 80 regrowth rate, i would split it into two sessions to achieve a higher density.

In my first run i would fill up the crown area from south to the north in circle form. has the benfit that in the next run you wont need as much grafts as before and you can still get a 60 or more density.

But what i wouldnt do with infinite donor is filling something sparsly because of you put more density in it the next time, maybe there will be complications like to dense or anything else. If my donor would give it and the regrowth rate is high, i would combine 1 2 in one session

05-29-2011, 08:16 AM
What you also can do is do the crown very little, which gives you more hairline and frontal grafts, and use toppik to cover it up.

Follicle Death Row
05-29-2011, 02:11 PM
True. Concealers can work with as little as 20FU/cm2.

06-01-2011, 11:33 AM
20 cm2???? If that's the case I think we shouldn't have to worry about anything anymore :P. I mean, I wouldn't like to wear a wig but if I could get FULL coverage with Toppik and a transplant that would restore enough hair for the full coverage thing with the Toppik to work, I would be happy for the rest of my life...