+ Reply to Thread
Results 1 to 8 of 8
  1. #1
    Senior Member
    Join Date
    Feb 2013
    Posts
    306

    Question Lifetime donor availability for FUE -vs- FUT

    I'm just wondering if anybody has knowledge of, or references for the donor availability of FUE and FUT? I remember hearing that the average person has 6,000-8,000 grafts over a lifetime, but is this for FUT alone? I've been hearing recently that FUE yields less grafts from the donor site than FUT over a lifetime and this has me worried. Even though I would prefer to undergo FUE for various reasons, I also do not want to undermine my future regarding graft availability in the donor area.

    Does FUE really yield less grafts from the donor area over a lifetime than FUT, and if so, by how much?

  2. #2
    Senior Member
    Join Date
    Feb 2013
    Posts
    306

    Default

    ?

  3. #3
    Doctor Representative 35YrsAfter's Avatar
    Join Date
    Aug 2012
    Location
    Alpharetta, GA
    Posts
    1,361

    Default

    Quote Originally Posted by Dav7 View Post
    I'm just wondering if anybody has knowledge of, or references for the donor availability of FUE and FUT? I remember hearing that the average person has 6,000-8,000 grafts over a lifetime, but is this for FUT alone? I've been hearing recently that FUE yields less grafts from the donor site than FUT over a lifetime and this has me worried. Even though I would prefer to undergo FUE for various reasons, I also do not want to undermine my future regarding graft availability in the donor area.

    Does FUE really yield less grafts from the donor area over a lifetime than FUT, and if so, by how much?
    That's a great question. Strip surgeons of course will tell you that FUT preserves the available donor better than FUE. I just asked Dr. Cole. He gave me several good reasons why FUE has the potential in the right hands to yield more grafts than FUT. One obvious reason is, with FUE, the available donor hair is greatly expanded beyond what is available in a removed strip. For instance, Dr. Cole removed and placed over 5,000 beard hair grafts on one of our repair patients. When properly placed it looks natural.

    Some will argue that FUE thins out the donor and they are right, but so does strip in a different way. Imagine blowing up a balloon a little and placing evenly spaced black dots all over it. Blow it up more and the spaces between the dots increase. Strip stretches the scalp and the distance between the follicular units increases causing the donor to look thinner.

    The bottom line is, the scalp donor is what it is and the missing hair due to strip or FUE is still missing hair, just revealed in different ways down the road.

    One could argue that hair is killed when the strip is cut. It's also been noted that the abrupt decrease in blood supply when the strip is cut out and closed, can cause shock loss and a permanently thinner area of hair growth. If you become one of those unfortunate patients who gets an unacceptably wide strip scar, repair requires that hair be used in the scar that could better be used in the MPB affected, bald and thinning areas. FUE, when properly done nearly always allows a man to wear his hair shorter without the appearance of scarring.
    Last edited by 35YrsAfter; 02-22-2015 at 05:39 PM.

  4. #4
    Senior Member gillenator's Avatar
    Join Date
    Dec 2008
    Location
    Washington DC
    Posts
    1,418

    Default

    Here's the deal. Only after viewing literally several thousands of results both with FUHT and FUE, can one make a fair comparison.

    Harvestable grafts really come down to three very critical factors in the equation.

    First of all, one's donor density is going to vary between patients. That's why you will hear of a range of 6,000 to 8,000 grafts. Without any collateral damage to the donor zones whether by excising (FUHT) or extractions (FUE), the lower end of 6,000 represents those individuals with average to lower end densities. The 8,000 figure obviously then is at the upper range. So donor density is important and will vary between patients.

    The second critical factor to consider is the "permanence" of the donor zone. This gets tricky because once hair shaft diameter comparisons are made, one's donor zone may not be as broad as originally thought based on periodic examinations that many times start at age 25 and above years of age. Then after the years go by, the donor zone that once was thought permanent can contract based on further and continued microscopic examination of hair shaft comparisons. And this is how a surgeon can potentially know on every procedure which defined area to stay within as time passes.

    In other words, the identification of the permanent zone in the occipital area where most strips are excised is ambiguous at best. It is all too often an objective conclusion yet a fair number of patients experience an expanded zone of miniaturization and then diffusion that impede the area that was once thought to be permanent.

    I should at this point define what is called the permanent zone. It is considered the area of scalp where DHT is not evident or better stated where there "appears" to be terminal hair that is DHT resistant. But that determination is based on the degree of caliber of that zone, "at that particular point in time".

    Yet time and time again, I see some guys who begin to see their donor zones thin and/or diffuse and even recess from the crown down into the coronet area (bottom end of the crown) where their strips and or FUE extractions were taken. Every now and then we see examples of where strips were taken very high in the occipital zone and then later the individual begins to lose hair in that very same area. Many of those individuals do not notice those changes until they get over 35 years of age and older into their 40s and so on.

    And I truly believe that the grafts (FUs) that were harvested from the broader areas of the occipital zone can be lost in the future years because they were in fact DHT receptive all along. The difference is that they had a stronger degree of caliber at the time they were harvested and all too often at the mid twenties of age.

    I have become so emphatic with the younger men to wait and also to look closely at the older men on either side of their families whether maternal or paternal. Looking for donor zone thinning and how expanded that thinning is. Why? Because nearly all of us have outstanding hair shaft diameter when we are under 30 years of age and the expanded zone of thinning and diffusion does not manifest until we get into our mid-thirties or so. Make sense?

    The third and last factor to consider is the skill of the surgeon whether we are talking about FUHT or FUE. Again I have to say that I have seen literally hundreds and hundreds of examples of poor skill in both arenas as well as superb work in both arenas. It then becomes "subjective" as to how many harvestable FUs can be harvested in one's lifetime. Once the FUs are damaged, they are damaged (transected). So the skill is absolutely imperative and ranks way up there on the decision making factor.

    Now, a couple of more comments. The stretching of the scalp with FUHT is not as permanent as one might think. Why? It's a simple answer. The scalp is so elastic that it will simply relax with time passing, and bring density back in the range. And even those with tighter scalps can opt for scalp stretching exercises which can bring back enough play in the scalp for another procedure. I know this firsthand having had four separate FUHT procedures myself for a grand total of 7,000 grafts. I still have one very fine thin strip scar. It is still extremely difficult to find.

    Another thing. It also depends in one's own physiology and auto-immune system. Some folks heal better than others so if you heal with a raised scar, then that can potentially negatively impact the amount of future available grafts for subsequent procedures.

    One other thing about FUE. FUE can potentially extract terminal hair that is on the sides of the scalp and/or the parietal zones of the scalp where strips cannot be taken. And depending on the density in those secondary donor areas, it can and will have an impact on the total number of available FUs for transplantation in the future.

    And beard zone grafts were mentioned but be "very careful" with that donor zone because beard grafts should never be used IMHO for commencing a hairline because of the coarseness of the hair shafts and the visual incompatibility with the softer caliber hair in the hairline. It can stick out like a sore thumb even if the angulation is proper. The wider the color contrast, the more beard hair shafts can and will be noticed to the naked eye.

    Maybe I should have stated five factors before starting the typing of this post....
    "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

  5. #5
    Senior Member
    Join Date
    Feb 2013
    Posts
    306

    Default

    Quote Originally Posted by gillenator View Post
    Here's the deal. Only after viewing literally several thousands of results both with FUHT and FUE, can one make a fair comparison.

    Harvestable grafts really come down to three very critical factors in the equation.

    First of all, one's donor density is going to vary between patients. That's why you will hear of a range of 6,000 to 8,000 grafts. Without any collateral damage to the donor zones whether by excising (FUHT) or extractions (FUE), the lower end of 6,000 represents those individuals with average to lower end densities. The 8,000 figure obviously then is at the upper range. So donor density is important and will vary between patients.

    The second critical factor to consider is the "permanence" of the donor zone. This gets tricky because once hair shaft diameter comparisons are made, one's donor zone may not be as broad as originally thought based on periodic examinations that many times start at age 25 and above years of age. Then after the years go by, the donor zone that once was thought permanent can contract based on further and continued microscopic examination of hair shaft comparisons. And this is how a surgeon can potentially know on every procedure which defined area to stay within as time passes.

    In other words, the identification of the permanent zone in the occipital area where most strips are excised is ambiguous at best. It is all too often an objective conclusion yet a fair number of patients experience an expanded zone of miniaturization and then diffusion that impede the area that was once thought to be permanent.

    I should at this point define what is called the permanent zone. It is considered the area of scalp where DHT is not evident or better stated where there "appears" to be terminal hair that is DHT resistant. But that determination is based on the degree of caliber of that zone, "at that particular point in time".

    Yet time and time again, I see some guys who begin to see their donor zones thin and/or diffuse and even recess from the crown down into the coronet area (bottom end of the crown) where their strips and or FUE extractions were taken. Every now and then we see examples of where strips were taken very high in the occipital zone and then later the individual begins to lose hair in that very same area. Many of those individuals do not notice those changes until they get over 35 years of age and older into their 40s and so on.

    And I truly believe that the grafts (FUs) that were harvested from the broader areas of the occipital zone can be lost in the future years because they were in fact DHT receptive all along. The difference is that they had a stronger degree of caliber at the time they were harvested and all too often at the mid twenties of age.

    I have become so emphatic with the younger men to wait and also to look closely at the older men on either side of their families whether maternal or paternal. Looking for donor zone thinning and how expanded that thinning is. Why? Because nearly all of us have outstanding hair shaft diameter when we are under 30 years of age and the expanded zone of thinning and diffusion does not manifest until we get into our mid-thirties or so. Make sense?

    The third and last factor to consider is the skill of the surgeon whether we are talking about FUHT or FUE. Again I have to say that I have seen literally hundreds and hundreds of examples of poor skill in both arenas as well as superb work in both arenas. It then becomes "subjective" as to how many harvestable FUs can be harvested in one's lifetime. Once the FUs are damaged, they are damaged (transected). So the skill is absolutely imperative and ranks way up there on the decision making factor.

    Now, a couple of more comments. The stretching of the scalp with FUHT is not as permanent as one might think. Why? It's a simple answer. The scalp is so elastic that it will simply relax with time passing, and bring density back in the range. And even those with tighter scalps can opt for scalp stretching exercises which can bring back enough play in the scalp for another procedure. I know this firsthand having had four separate FUHT procedures myself for a grand total of 7,000 grafts. I still have one very fine thin strip scar. It is still extremely difficult to find.

    Another thing. It also depends in one's own physiology and auto-immune system. Some folks heal better than others so if you heal with a raised scar, then that can potentially negatively impact the amount of future available grafts for subsequent procedures.

    One other thing about FUE. FUE can potentially extract terminal hair that is on the sides of the scalp and/or the parietal zones of the scalp where strips cannot be taken. And depending on the density in those secondary donor areas, it can and will have an impact on the total number of available FUs for transplantation in the future.

    And beard zone grafts were mentioned but be "very careful" with that donor zone because beard grafts should never be used IMHO for commencing a hairline because of the coarseness of the hair shafts and the visual incompatibility with the softer caliber hair in the hairline. It can stick out like a sore thumb even if the angulation is proper. The wider the color contrast, the more beard hair shafts can and will be noticed to the naked eye.

    Maybe I should have stated five factors before starting the typing of this post....

    So you are saying that FUT yields the greatest number of grafts? Also, does it make a difference on the hairline which technique is used, e.g. is it true that "finer hairs" extracted by FUE create a better hairline? Or is this untrue?

  6. #6
    Doctor Representative 35YrsAfter's Avatar
    Join Date
    Aug 2012
    Location
    Alpharetta, GA
    Posts
    1,361

    Default

    Quote Originally Posted by gillenator View Post
    The second critical factor to consider is the "permanence" of the donor zone. This gets tricky because once hair shaft diameter comparisons are made, one's donor zone may not be as broad as originally thought based on periodic examinations that many times start at age 25 and above years of age. Then after the years go by, the donor zone that once was thought permanent can contract based on further and continued microscopic examination of hair shaft comparisons. And this is how a surgeon can potentially know on every procedure which defined area to stay within as time passes.
    Excellent information gillenator. I'm a perfect example of someone who had way above average donor characteristics in my twenties. It thinned out and the hair I had transplanted in my late twenties of course thinned as well. Not such a bad thing in my case because the work I had done did not look natural. Thinning improved my appearance a little on top at least. My experience really underscores the reality that thin looking, natural appearing hair, is preferable to dense, poorly placed hair.

    Of course, I'm not speaking favorably of donor area thinning. I had a real bad case of that back around 2005. I was taking Ibuprofen, glucosamine/chondroitin and Allegra for allergies. This combination wasted my donor. I stopped taking these meds and started up using Rogaine again. Things have improved there considerably.

    I'm looking forward to new next-generation treatments. Since PGD(2) has been identified as an inhibitor of hair growth, researchers have their eye on the PGD(2)-GPR44 pathway as a potential target for treatment. Even now there are relatively inexpensive things a young man can do to preserve the hair they have to varying degrees.

    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
    Last edited by 35YrsAfter; 02-22-2015 at 05:39 PM.

  7. #7
    Senior Member gillenator's Avatar
    Join Date
    Dec 2008
    Location
    Washington DC
    Posts
    1,418

    Default

    Chuck,

    I also have experienced a light stage of donor zone thinning and it was not until my father turned 65 that I noticed his donor thinning. Yet he always had the thickest head of hair most of his life.

    My older brother does not have it and he is 60, my younger brother has it worse than me and he is 57.
    "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

  8. #8
    Senior Member gillenator's Avatar
    Join Date
    Dec 2008
    Location
    Washington DC
    Posts
    1,418

    Default

    Dav7,

    No I'm not saying that FUHT necessarily yields more grafts, again, it really depends on the skill of the surgeon whether it's FUE or FUE.

    Probably 3-5 years ago, FUE yields were not as consistent as they are today in the right hands.

    And yes FUE can allow the skilled surgeon to "cherry pick" softer texture hair to use on the hairline.
    "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

Similar Threads

  1. Donor pain
    By 3rd time in forum Hair Transplant: Start Your Own Topic
    Replies: 8
    Last Post: 08-26-2013, 01:15 PM
  2. GCs donor pic 24 days after 3000 grafts-donor density
    By didi in forum Techniques in Possible Donor Regeneration and Multiplication
    Replies: 19
    Last Post: 02-22-2013, 04:58 PM
  3. Maximum number of grafts in a lifetime?
    By prodigy in forum Hair Transplant: Start Your Own Topic
    Replies: 8
    Last Post: 06-17-2011, 12:03 PM
  4. Does scalp reduction, strip, or donor stretching reduce donor density?
    By CIT in forum Hair Transplant: Start Your Own Topic
    Replies: 0
    Last Post: 09-17-2009, 02:05 PM
  5. Variable donor density & Efficient donor harvesting
    By CIT in forum Men's Hair Loss: Start Your Own Topic
    Replies: 0
    Last Post: 01-16-2009, 10:41 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

» IAHRS

hair transplant surgeons

» The Bald Truth

» Recent Threads

1800 graft repair case results by Dr. Lindsey
Yesterday 08:38 AM
Last Post By Dr. Lindsey
Yesterday 08:38 AM
Navigating the German Job Market as a Kenyan Citizen
11-04-2023 06:31 AM
Last Post By Keegan212
Yesterday 03:51 AM
DR HAKAN DOGANAY/ 4500 GRAFTS / Implanter Pen+FUE
03-26-2024 04:15 PM
Last Post By Hakan Doganay, MD
03-26-2024 04:15 PM
The Mane Event for Thursday, June 15th, 2023
06-15-2023 02:59 PM
Last Post By gisecit34
03-26-2024 08:05 AM