Fue vs Strip

[ebutterg]

Edited for retraction

[CIT_Girl]

You accuse Dr. Cole of ignoring “very material facts” but, to be fair, he has performed far more FUE/CIT procedures in the U.S. than any other doctor, and these procedures have been 90-100% of his practice since 2003. Other doctors may limit FUE procedures to 3,000 grafts but a lot of these self-proclaimed FUE doctors are actually relative novices when it comes to FUE: they only have a few years experience, they have limited instrumentation, and/or their offices aren’t primarily dedicated to FUE. Almost every doctor claims that they perform FUE but almost all have indicated they believe FUE is only for very small procedures, such as scar grafting. If you truly want to be the best at something, you have to believe that it works. Since he developed his CIT procedure, Dr. Cole has always viewed it as a stand-alone technique for all patients, superior to any other method out there. Dr. Cole has numerous patents and patent applications relating to FUE, and has developed all his own instruments for the technique (FUE instruments were non-existent when he started). We have a full-time engineer on staff to further the advancement of CIT, independent global licensees who were trained by Dr. Cole and many results on our website dating back to 2003. I think most people would concede that Dr. Cole is an authority on FUE.

The majority of purported FUE doctors may draw the line at 3,000 grafts, less than 20% of the 16,600 follicular units in the average donor region, but why? Maybe some doctors don’t like the drudgery or time it takes to perform larger FUE sessions; maybe they lack proper instrumentation or skill. Regardless, you can certainly take more than 25% of the donor area, and sometimes up to 50%, while still maintaining an acceptable level of coverage.

You reference “buckshot” scarring in your post. The fact is, some patients will heal flawlessly and some will heal with the small white dots (called hypopigmentation). We can’t predict who will get them and who will not, though lighter-skinned individuals tend to have better healing. We’re currently researching a possible solution whereby we apply ACell to extraction sites to see if it may alleviate the appearance of hypopigmentation. For patients who do develop hypopigmentation, they can simply grow their hair to 1 to 3 millimeters in length and it will be completely hidden.

In contrast, the second you have a strip surgery, you will have a scar and it will be visible if you shave your head: it will look like you had a surgical procedure on the back of your head. With your hair at 1 or 3 millimeters in length, the scar will still be apparent. Why discourage people from having a procedure that, in the worst case scenario, will require you keep your hair 1 to 3 millimeters long to hide a reduction in pigmentation, yet endorse a procedure in which you can never again shave your head?

Per your request, I’ve attached pictures of three procedures. In these photos, you can see the donor region of three different patients following a 5,000 graft surgery, a 5,700 graft surgery and a 9,200-graft surgery. The latter is shown as a close-up and wet since it was non-shaven. This patient’s hair is certainly not as thick as it was prior to having any procedures, yet this patient certainly wasn't disappointed in the cosmetic appearance of his donor region, particularly considering that his hair was completely restored using almost 10,000 grafts.

1. (5,000 grafts)

2. (5,700 grafts)

3. (9,200 grafts)

[Winston]

Very impressive pictures CIT girl. I certainly think it was inappropriate for ebutterg to accuse you or Dr. Cole of exaggerating your clinics ability to perform large FUE sessions. The proof lies in the results and it appears that you guys do a top notch job. I’m not sure if FUE is superior to FUT, that’s debatable, but I do think it’s a good option for a lot people and Dr. Cole is one of the best that I’ve seen online.

[CIT_Girl]

Well, thanks for your comment Winston...I know you're a veteran poster, very knowledgeable and well-respected on this board so that means a lot coming from you!

[bigmac]

Hi CIT Girl.

5000 grafts is an awful lot to extract via FUE imo,would it be possible for you to post the immediate post op pictures of the above patients showing the extraction sites and the area they were extracted from.
This way we can truly compare the the post op look.
Thanks bm.

[CIT_Girl]

Some additional info about larger sessions:

The average number of follicular units in a typical donor area is 16,600, within approximately 203 sq cm of surface area. It’s important to customize each transplant to the patient. If someone is Norwood Class V, they have about 180 sq cm of hair loss, class VI may have 220-250 sq cm of hair loss. Mathematically, it is sometimes impossible to deliver a reasonable degree of coverage in these individuals. When Dr. Cole performs a procedure, he first assesses what the patient wants, and then determines if it is possible to actually deliver what he wants. If the patient’s expectations exceed what is reasonable, it’s in the best interest of everyone to avoid surgery. If he determines that the patient has realistic expectations based on their degree of hair loss and their overall donor capacity, he will consider an approach to the donor area that allows him to provide the maximal benefit with the greatest aesthetic result.

If someone has enough hair loss to require 5,000+ follicular units in a single procedure, they may or may not be good candidates for hair restoration surgery. Someone who would require this many would likely be somewhere between a Norwood V and VI. It’s important to keep in mind that the one absolute, when it comes to hair restoration, is that hair loss is a progressive condition. Therefore, the approach to the patient needs to take this into account. Even though someone is an acceptable candidate for 5,000 grafts in a single procedure, a procedure will not necessarily be in the best long-term interest of the patient. For example, for a patient in their late twenties, or early thirties, and already showing class V with potential for class VI hair loss, adding hair to the crown area will likely result in isolated hair in the center of the crown, with a perimeter that lacks hair coverage in years to come. Removing 5,000 grafts today significantly depletes available donor supply for the future. Obviously someone who starts out with 20,000 follicular units today is going to be a much better candidate for additional coverage in later years; unfortunately these individuals are not the norm.

When Dr. Cole plans to maximally harvest a donor area in the initial procedure via FUE, he typically removes somewhere between 20 and 25 percent of the available follicular units. On an average individual, this would be somewhere between 3,000 and 4,000 grafts in a single pass. It is certainly possible to harvest a greater percentage than this, yet it is commonly not in the best interest of the patient. Consider that treatment of the frontal area, by itself, will maximally take somewhere between 2,000 and 3,500 grafts in a single pass. The objective many times is to focus on the front with the hope that restoration of coverage here will reduce an indiviudal’s concern about hair loss in their vertex/crown region. If Dr. Cole is successful in achieving a degree of satisfaction with a focus on the front, he has succeeded in reducing overall cost for the patient, and the potential pitfalls of opening the “Pandora’s box” of grafting the crown. This is a conservative approach and one that is generally in the best interest of the patient and that works best. Such an approach also leaves a “safety net” of donor hair for future procedures should the patient desire additional work in the frontal area to maximize density or fill in progressive hair loss, such as at the lateral rims of the scalp. The danger in trying to create maximal density in an individual who’s heading towards a Norwood VI is that they might end up having the isolated frontal forelock, similar to Joe Biden. This would obviously not be in the best interest of the patient and frankly looks unnatural (this is not a typically naturally occurring pattern of hair loss). Another approach to the crown area involves adding light coverage to make it appear that the patient is losing hair, rather than to try maximally cover crown. Such an approach allows an individual to maintain a normal appearance as they mature and continue to lose hair. Essentially, just because you can do 5,000 grafts does not mean you should, and Dr. Cole more typically takes a conservative approach.

In the photographs we posted, only one individual had 5,000 grafts in a single pass; the other two had multiple procedures to reach their total graft numbers. The patient who had 5,000 grafts at once was an older gentleman and his hair loss pattern was more stable based on his age (he was a Norwood VI). The patient who had 5,700 grafts was also a Norwood VI and he had two procedures to achieve this number of grafts; because he was younger, the approach was more conservative initially. The patient who had 9,200 total scalp grafts was a Class III Vertex who progressed to a V over a number of years. Hair was added throughout the top of the scalp in multiple procedures dating from 2003.

The overall objective with FUE is to gradually thin out the donor area so that the overall density in the donor and recipient areas become more similar. We find this to be a more natural approach than cutting out a large strip of hair-bearing scalp, as strip surgery involves. Also, with strip surgery, the available donor area is only about 160 sq cm, because you can’t harvest from the nape of the neck without leaving too wide of a scar (with FUE, on the other hand, you can typically harvest from over 203 sq cm of donor hair). It is perhaps even more important to err on the side of caution when it comes to large sessions via strip. Assume you have 80 follicular units per sq cm of scalp. If your surgeon were to remove 5,000 grafts, 62.5 square centimeters would be needed to achieve this, which would leave you with only 100 sq cm of un-harvested scalp (and a linear scar right in the middle).

[bigmac]

Thanks for the additional info but i would still like to see the imm post op pictures of the above patients.
Although the huge session was multiple procedures you could post all the post op pictures from the different surgery`s.Then we can see what the donor area looks like after this many extractions.
Thanks bm.