Results: Clinical Investigation comparing FUT vs FUE

[Carlos Wesley, MD]

The work of a respected physician in our field, Dr. Michael L Beehner, may provide the most objective data yet comparing the yield of grafts using follicular unit transplantation (FUT) versus follicular unit extraction (FUE).

While I still believe that there are numerous methods not used in his investigation to optimize growth, the effort to minimize the number of variables that may influence survival rates of grafts was considerable. Ultimately, it’s important that physicians are proficient in both methods (FUT and FUE) in order to provide patients with unbiased and objective information regarding both methods of surgical hair restoration.

[Carlos Wesley, MD]

The solutions in which the transplanted hair follicles are stored when out of the body can have a profound impact on the ultimate procedural result. Here is a an example of a patient who had two FUT ("strip") procedures at a different surgical practice in NY before having an FUE session with our group. The images show him before and after the FUE session. Clearly, his results and graft survival were not consistent with the findings of this investigation.

[Driver]

This is clearly a very small and very limited study, but it does at least on the surface confirm a lot of what is suspected about FUT versus FUE.

[hanginginthewire]

I often wonder why FUE is so popular when there are so many drawbacks to it. Less yield, lower survival rate, reduced donor area. This thread here put the question to a poll and yet the results were overwhelmingly for FUE.

http://www.hairlosscure2020.com/two-hair-transplant-related-polls-fut-or-fue-and-bht/

Is it just fear of a scar? I don't get it.

[HTsoon]

I often wonder why FUE is so popular when there are so many drawbacks to it. Less yield, lower survival rate, reduced donor area. This thread here put the question to a poll and yet the results were overwhelmingly for FUE.

http://www.hairlosscure2020.com/two-hair-transplant-related-polls-fut-or-fue-and-bht/

Is it just fear of a scar? I don't get it.

To be honest there haven't been any conclusive studies that show the difference in yield is even visible, lower graft survival rate is also inconclusive because not all surgeons are created equal, in this particular study you have a surgeon who only performed about 10 FUE surgeries per year, my doctor performs more then 10 FUE surgeries per month, the difference of someone who only performs something 10 times a year compared to someone who does it everyday is going to be substantial.

In regards to "reduced donor area" its actually the opposite, with FUE you are able to take every graft in the "individual safe donor area" I say individual because the "safe donor area" of a strip is based upon Norwood VII level of baldness, however we know that this level of baldness is actually quite rare and the extreme, the vast majority of men if left untreated are more likely to progress to Norwood V,VI level of hair loss. Therefore, the safe donor area of a man who's Norwood VI is larger than that of a Norwood VII. A microscopic miniaturization evaluation of the donor area will help asses the "individual safe donor" area.

It's a shame that so many strip physicians demonize FUE as an inferior procedure, the truth is that FUE in the right hands can rival any FUT result, both procedures have their place in hair restoration, in my opinion there is no right or wrong, there is only what best fits the patient, with out a doubt combining both procedures will allow you to maximize your grafts, however if you choose a good surgeon the difference in yield from either or is negligible. With that being said, the learning curve for FUE is a lot higher and if a surgeon is not careful with extracting, removing, storing, and placing the grafts then the chances of a poor result are substantially increased. For this reason, I believe many surgeons choose not to learn FUE.

However, like anything practice makes perfect, and now there have been surgeons who have devoted their entire practice to perfecting FUE, and as such you see Norwood VI transformations utilizing only FUE like myself, this was unseen 10 years ago.

[pkipling]

I agree with everything HTsoon said above. There is so much misinformation out there, and the fear mongering surrounding FUE with "studies" such as this one don't do anything to help men who suffer from MPB and are looking for actual answers and guidance. Not all hair transplant surgeons are created equal, and people need to look at the work of individual doctors and the results they produce and steer clear of blanket statements you'll find online about how "Strip is better than FUE" and whatnot. As with most things in life, it's not really that black and white.
__________________
I am a patient advocate for Dr. Parsa Mohebi in Los Angeles, CA. My views/opinions are my own and don't necessarily reflect the opinions of Dr. Mohebi and his staff.

[Driver]

I've said this before. Both of these surgeries have pros and cons. That's just the reality. People who argue very strongly for one over the other often have some sort of bias: either it lines their pockets with money (docs) or it validates the decisions they have made (pts).

If you want to have hair transplant, pick the surgery that you are most comfortable with and that you think is the best fit for you. I suspect both of these procedures will be around for a long time.

[hanginginthewire]

Great posts guys, thanks a lot. I'm still confused though, lol. Because the impression I'm left with is still that FUE is just as good as FUT, provided you have a competent surgeon, etc. If that's the case - that FUE can SOMETIMES achieve just as much as FUT, why not just have an FUT procedure, since the FUE doesn't surpass the FUT results, it only meets them. (With lack of a linear scar being the one, really big exception obviously). So again, with the exception of linear scar, what is the reason for choosing FUE? I know FUE has a shorter recovery time or you can exercise sooner or whatever but those seem like minor issues. For there to be such an overwhelming preference for FUE confuses me. I've heard guys say only a fool would go FUT nowadays etc and outside of the scar concern I have no idea why.

This guy here seems to be the YouTube hair transplant guru and he seems adamant that you should never have FUE as your initial procedure:

https://m.youtube.com/watch?v=7GGRjWRHMpY

Dunno, its just confusing.

[Pittdawg]

Great posts guys, thanks a lot. I'm still confused though, lol. Because the impression I'm left with is still that FUE is just as good as FUT, provided you have a competent surgeon, etc. If that's the case - that FUE can SOMETIMES achieve just as much as FUT, why not just have an FUT procedure, since the FUE doesn't surpass the FUT results, it only meets them. (With lack of a linear scar being the one, really big exception obviously). So again, with the exception of linear scar, what is the reason for choosing FUE? I know FUE has a shorter recovery time or you can exercise sooner or whatever but those seem like minor issues. For there to be such an overwhelming preference for FUE confuses me. I've heard guys say only a fool would go FUT nowadays etc and outside of the scar concern I have no idea why.

This guy here seems to be the YouTube hair transplant guru and he seems adamant that you should never have FUE as your initial procedure:

https://m.youtube.com/watch?v=7GGRjWRHMpY

Dunno, its just confusing.

It's not that confusing; you keep saying "other than the linear scar" but that's the whole point, many men like to keep their hair short and FUE gives you the option of going much shorter than FUT. Conversely, FUT appears to give a higher yield so it really boils down to what your goal is, i.e. as little trace of any scar as possible for short hair or maximum amount of transplanted follicles.

[HTsoon]

Great posts guys, thanks a lot. I'm still confused though, lol. Because the impression I'm left with is still that FUE is just as good as FUT, provided you have a competent surgeon, etc. If that's the case - that FUE can SOMETIMES achieve just as much as FUT, why not just have an FUT procedure, since the FUE doesn't surpass the FUT results, it only meets them. (With lack of a linear scar being the one, really big exception obviously). So again, with the exception of linear scar, what is the reason for choosing FUE? I know FUE has a shorter recovery time or you can exercise sooner or whatever but those seem like minor issues. For there to be such an overwhelming preference for FUE confuses me. I've heard guys say only a fool would go FUT nowadays etc and outside of the scar concern I have no idea why.

This guy here seems to be the YouTube hair transplant guru and he seems adamant that you should never have FUE as your initial procedure:

https://m.youtube.com/watch?v=7GGRjWRHMpY

Dunno, its just confusing.

I can't speak for others but the reason why I chose FUE is because in the event that I continue to lose more hair, I will maintain the option of buzzing my head (not shaving). This reason alone was enough for me to decide on FUE, the issue with the linear scar is it limits the hairstyles you can have, you will no longer be able to wear your hair shorter then a #3 if you have a really good scar or #6 if you have a stretched scar. The option of buzzing your head in the future is completely eliminated.

We know that surgery is not guaranteed, no body can guarantee you a successful surgery, so the overwhelming majority of men want to maintain the option of buzzing their head if their procedure fails. Previously patients with botched surgeries had to endure growing their hair long on the side while having a terrible pluggy transplant on top, the contrast is obvious, having hair shorter on the sides helps mitigate the contrast, I don't know about you but this is a big deal to me and a big deal to most men as proven by that poll.

I respect David a lot for coming forward with his surgery and making the public more aware, keep in mind his first doctor claimed to be Jesus and lost his license, he relocated to Florida to practice, this is all well documented, both of his doctors do not perform FUE, his most recent doctor only performs FUE in to strip scars, David is only repeating what the doctors he respects tell him, it's not uncommon for this to happen, in America we are taught to follow your doctors instructions without question because they know best. This is where critical thinking should come in to play.

As stated previously, the loudest proponents to FUT are doctors WHO DO NOT perform FUE, why do you think this happens? with FUE's popularity on the rise they need to do something to keep prospective patients from looking elsewhere. It's all a form of marketing, when I was researching FUE vs FUT, what I did was I combed through the forums for patient reviews with similar hair loss patterns and similar amount of grafts, when I began to objectively look at the results, I found that there really wasn't much of a difference between FUE and FUT in the elite doctor realm. The biggest difference was the inability to where your hair short with one procedure. The goal of any surgery should be maximizing the yield on top whilst keeping the donor area looking untouched, if done properly I think FUE supersedes FUT in that aspect. Again, FUT is a great procedure and it WILL always have its place in hair restoration, for those patients on a budget who need to move as many grafts as possible for the lowest price FUT will be #1. You should always think critically and research things for yourself, remember hair restoration is a business, and as such doctors need to maintain their businesses always keep that in mind. Hope this info helps.

[hanginginthewire]

Thanks, another really helpful post from you. My biggest concern is worst case scenario, I guess I am a diffuse thinner and fear I could end up as a Norwood 7. The general consensus I see online seems to he that higher Norwoods need FUT. But could you say a little more about buzzing your hair vs shaving it? I can't forsee shaving slick bald ever in my life as I don't like how it looks on me. Buzzing and being able to still frame my face then yeah I could live with that. Are you familiar with fred the belgian's story:

https://www.*****************/intera...rom-dpa.79560/

But why would you be concerned about that..isn't the vast majority on top of your head transplanted hair?

[HTsoon]

Thanks, another really helpful post from you. My biggest concern is worst case scenario, I guess I am a diffuse thinner and fear I could end up as a Norwood 7. The general consensus I see online seems to he that higher Norwoods need FUT. But could you say a little more about buzzing your hair vs shaving it? I can't forsee shaving slick bald ever in my life as I don't like how it looks on me. Buzzing and being able to still frame my face then yeah I could live with that. Are you familiar with fred the belgian's story:

https://www.*****************/intera...rom-dpa.79560/

But why would you be concerned about that..isn't the vast majority on top of your head transplanted hair?

There is a difference between buzzing and shaving, buzzing is with a clipper either #1 or no guard, shaving is with a razor down to skin, you will never be able to shave if you have a transplant, doesn't matter if you choose FUE or FUT. However, with FUE i'd say a good amount of men are able to buzz down no guard and the majority to a #1.

Yes the majority of the hair on my head is transplanted, but as stated previously NO SURGERY is guaranteed, even the BEST hair transplant surgeons get bad results, so before I had surgery I thought "what if I am one of the unlucky patients that get a bad result"? what would be my next step? well before having any transplants I thought "if it fails i'll keep my head buzzed and move on". Before having a transplant I would suggest you buzz your head at least once to see if you could live with it, I buzzed my head for a year before getting a transplant. Had I got FUT and gotten a bad result, I would be stuck with a botched diffused hair transplant and long thick sides, so to me FUE was an insurance policy. It's not only about wearing your hair short, although that is a HUGE plus, it has a lot to do with an escape route.

With that being said, I just want to reiterate that FUE is not scarless, and you will NEVER be able to shave your head without seeing scars. That's why I had to clarify buzzing and not shaving.

I'm not familiar with the thread you posted but I will check it out.

[hanginginthewire]

I've actually shaved my head to the bone...I was pretty horrified by it. You make compelling points and they make my head spin because one day I am convinced that FUT is best and then the next I agree that FUE makes sense. What would be the reasons - if any - for having FUT in your opinion? And what do you think about FUE taking hair that is not in the "sweet spot" of the donor zone? My nape hair definitely is thinning/balding and I wouldn't want hair transplanted from there. Thanks for addressing my concerns I know I'm full of questions. Unfortunately I'm pretty preoccupied with all this stuff at the moment.

[hanginginthewire]

Also what are some ways of trying to estimate your likely "final" level of baldness? There's got to be something at my age of late 30s.

[hanginginthewire]

Also if you are a "diffuse thinner" - which I believe I am - (patterned though), does that mean you will lose ALL the hair on top of your head or might you keep some?