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  1. #1
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    Default If you start with FUE?

    I saw this question posted on another forum from years ago and it totally summed up the question Ive been formulating in my head:

    If I am getting a small proceedure not...say 700 grafts FUE....and one day the bottom falls out and I become a NW 6 (I do not think that is likely to happen as I am almost 32 and there is no sign of such pattern)....but say that happens...and I need a large session....if you start with FUE does that reduce the total amount of grafts you will eventually be able to get?

    I talked to SMG and Matt said that you can only get 4 to 5 K grafts total FUE and if you just go strip you can get 8 k plus Strip.....so my question is....

    If you get 4 or 5K grafts fue.....can you still get the next 3k or so strip if you really need them?

    My question is, no matter what order you do it in.....is the TOTAL number of grafts going to be pretty much the same?

    I hope you can understand the question....I am trying to get an idea for what I want my master plan to be.
    So to sum up: is there any disadvantage to starting with FUE and getting FUT done later assuming I go to a great surgeon.
    Apologies guys about all the questions Ive been throwing at the forum. Im intensely investigating at the moment and am close to making up my mind

  2. #2
    Doctor Representative 35YrsAfter's Avatar
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    Quote Originally Posted by bighair View Post
    I saw this question posted on another forum from years ago and it totally summed up the question Ive been formulating in my head:



    So to sum up: is there any disadvantage to starting with FUE and getting FUT done later assuming I go to a great surgeon.
    Apologies guys about all the questions Ive been throwing at the forum. Im intensely investigating at the moment and am close to making up my mind
    When a strip is done later down the road after FUE, there will be less hairs in the strip that is removed due to FUE harvesting. One solution is to take a slightly wider strip, so care must be exercised not to stretch the scalp too tight which can result in a strip scar that widens down the road.

    35YrsAfter also posts as CITNews and works at Dr. Cole's office
    Cole Hair Transplant - Atlanta, GA
    Phone 678-566-1011
    Last edited by 35YrsAfter; 02-22-2015 at 09:17 AM.

  3. #3
    Senior Member gillenator's Avatar
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    If the patient has the potential for considerable future loss, then most of these individuals are going to want/need more procedures in the future. Very few HT patients can get by with one procedure in their respective lifetimes.

    This is why I am still more of an advocate to start with strip to achieve the most yield and coverage and at the same time, limiting the collateral damage in the donor zone from FUE.

    FUE can later also open other donor zones such as the parietal areas that strip cannot or should not reach while the main strip specimens are primarily harvested from the occipital zone.
    "Gillenator"
    Independent Patient Advocate
    more.hair@verizon.net

    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

  4. #4
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    Quote Originally Posted by gillenator View Post
    This is why I am still more of an advocate to start with strip to achieve the most yield and coverage and at the same time, limiting the collateral damage in the donor zone from FUE.
    this is worrying for me should I decide to go with FUE first. I have heard mixed opinions on this now. If you started with a really good FUE doctor and then had strip 10 years down the line, overall would it not be much the same total amount as if you did it in the reverse order? Or would the differences be significant?

  5. #5
    Senior Member gillenator's Avatar
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    It really comes down to the quality of the patient's scalp tissue and the skill of the surgeon doing the FUE. If the surgeon for example is not that proficient in the manual extraction process, collateral damage can be done to the neighboring FUs immediately bordering the extraction sites. Please allow me to explain further.

    It's the effects of torsion (twisting force), traction (pulling force), compression (squeezing force), etc that can damage the neighboring tissue. If the patient's scalp tissue is more of the softer or "mushy" texture, then the collateral damage can be even more extensive. Even with the most ideal scalp texture, this type of damage can be done if the surgeon's manual extraction skills are sub par.

    With strip, and providing the surgeon is proficient, the strip specimen can be removed without the same level or extent of collateral damage.

    Further, Drs. Bernstein and Rassman developed and used to administer a pre-op FUE test called the FOXX test which primarily analyzed the type and composite of scalp tissue the proposed FUE patient had. They were several of the first North American based HT surgeons to practice FUE. If the patient's scalp was evaluated as too soft, the patient was recommended for strip instead. Not sure if they both still administer this test because they no longer are in practice together to my knowledge, nor have I heard of other doctors using the FOXX test.

    Softer tissue compresses more readily and therefore recesses as the punch is driven into the sub layers of the scalp. This is where the neighboring FUs and tissue can be potentially damaged, some of them permanently.

    Conversely, a sharp scalpel is used to "excise" the strip (precisely cut) as compared to the forces of extraction (FUE).

    Although strip does leave a strip scar, it does not radically change the integrity of the remaining FUs in the donor zone nor leave a potential patterned shotgun thinned appearance that FUE sometimes does produce. And the patient is still left with an intact donor zone on both sides of the scar that in most cases successfully hides the strip scar. Sure, a real short hairstyle may not be possible with strip but I know many guys that had sizable FUE sessions and cannot buzz their scalps either. Some can and some cannot.
    "Gillenator"
    Independent Patient Advocate
    more.hair@verizon.net

    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

  6. #6
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    Quote Originally Posted by bighair View Post
    this is worrying for me should I decide to go with FUE first. I have heard mixed opinions on this now. If you started with a really good FUE doctor and then had strip 10 years down the line, overall would it not be much the same total amount as if you did it in the reverse order? Or would the differences be significant?
    Ten years down the line both strip and FUE may be technically obsolete. Several months ago I overheard Raymond Konior MD and Dr. Cole expressing their frustration over the length of time it takes the majority of hair restoration physicians to get up to speed with current technology. For example, doctors placed grossly unacceptable plugs for way too many years even after there were proven superior methods that provide vastly more natural results.

    Arguments regarding strip vs FUE will continue to wage. Dr. Cole just mentioned to me that the FOXX test was proven to be of no value in 2003. Groundbreaking healing and regenerative technologies are what is driving current-day improvements in hair restoration surgery.

    You remove a strip and it's gone forever. On the other hand, I have seen the best strip scars that I personally would prefer over the worst FUE dotting. I have also seen horrible stretched strip scars that are far worse than the worst fue donor areas I have ever seen. IMO, the ideal patient for strip would be someone who has good laxity and a reasonably wide area of consistent hair shaft diameter and hair direction from where the strip could be taken.

    The photo below reflects a great strip scar but there are 2 other problems. This photo illustrates what can happen when you disrupt the natural hair shaft gradation and marry scalp with different hair directions. I can't imagine how a doctor could fix that. On the other hand, if you get some white dotting, a doctor could always place chest or beard hair in the extraction sites. FUE done right nearly always allows for cosmetically acceptable shorter hair cuts than strip surgery and with current advances in healing technology and regenerative medicine, things are just going to get better.
    Attached Thumbnails Attached Thumbnails Click image for larger version

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    Last edited by 35YrsAfter; 02-22-2015 at 09:18 AM.

  7. #7
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    As a patient of many different types of procedures and observing this industry for close to 30 years now I highly recommend starting with FUE. Have a procedure of 500 or less. This will give you the opportunity to see exactly what you are getting yourself into with the option of being able to step away from it all. You then only need to trust yourself and what you see and not depend on someone else. Unfortunately there are just too many dishonest people in this business and it becomes very confusing for most and I believe those that are in the industry and are honest would agree.

    It is the absolute safest approach outside of not having a procedure at all.

  8. #8
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    Quote Originally Posted by topcat View Post
    As a patient of many different types of procedures and observing this industry for close to 30 years now I highly recommend starting with FUE. Have a procedure of 500 or less. This will give you the opportunity to see exactly what you are getting yourself into with the option of being able to step away from it all. You then only need to trust yourself and what you see and not depend on someone else. Unfortunately there are just too many dishonest people in this business and it becomes very confusing for most and I believe those that are in the industry and are honest would agree.

    It is the absolute safest approach outside of not having a procedure at all.

    Thanks for the input topcat. Yeah I have to admit I am getting confused by the different sources of information on the topic. I met a consultant from Hasson and Wong yesterday. Obviously they are leaders in the field of FUT, and the consultation was great in explaining everything to me. However Im now even more confused about what I should do. I get the impression that if I go to a good FUT surgeon, the scar will basically be a non issue and overall I will be able to get a much larger amount of hair transplanted. I wish there was only one procedure because then I wouldnt have to spend so much time figuring out which one to go with.

  9. #9
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    The confusion is not uncommon. Whenever someone mentions that to me, I always ask how long they have been doing research and what they have been researching. Basically they often state that they are reading just about everything that they can online and a sense of being overwhelmed sets in.

    Sometimes along with this confusion they also begin to develop a level of impatience, frustration, and indecisiveness. Again, not uncommon and certainly understandable.

    IMHO, it's a good idea to take a break from it and whatever you do, clear your mind and emotions for a period of time.

    Then, when you come back, you will do so with a much clearer mind. Start making a comparison between the two methods on paper. Make two columns that are titled "benefits" and "risks". Write down or type on a Word document both the benefits and risks for FUE. Then on another document do the same for Strip. You already know your goals so ask yourself how either technique best achieves your ultimate goal.

    What you will find is that things start making more sense. You have already archived this information in your memory bank and so as you begin to make those comparisons, you will find the information makes more sense next time and then you end up making an "informed decision".

    In addition by making these written comparisons, you will find yourself wanting a few issues further clarified but it will make more sense this time and you will have a better idea in how it relates to your own situation and goals. You can do the same comparisons with surgeons. It also results in having more confidence in the decision making process. Some patients end up deciding that HT surgery is not for them after all. Again, they make the decision being informed and more confident.

    I also give the same advice to individuals who are trying to make career decisions. Make the lists, start comparing benefits and shortcomings of the career position and it definitely helps point them in the direction that they feel will best achieve their goals.

    Best wishes to you.
    "Gillenator"
    Independent Patient Advocate
    more.hair@verizon.net

    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

  10. #10
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    I intentionally do not take the time go over each and every word that I write when I posting to a forum. I simply do not have the time, do not think it’s necessary as I’m not trying to project a specific image, and I prefer to write as I might speak to you if you were standing in front of me. I believe in basic common sense and just getting to the point and the point is this suggestion.

    Find at least 10 patients who do not work in this industry and have had experience with both procedures. Interview them preferably in person or on the phone, see what you find out and then report back to us. You will learn much more and you will count your blessings that you did this little exercise. Use the PM function on the various forums or simply ask for a contact e-mail in a posting.

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