FIT vs. Strip

[Chief]

I have just decided after 5 years of considering my options to go forward with surgery. I will most likely be having it done in January of 2007.

I am now trying to decide on which doctor to use and which type of extraction. I was originally leaning towards FUE/FIT but now I am strongly considering Strip. For instance, if I need 3000 graphs that would be approximately $23,000 with FUE/FIT. However, with Strip it would be about $12,000. That is a considerable savings. However, money really is not a deciding factor in my decision. I want the best results possible.

My questions:

Are there ANY differences in the end result in the recipient area between the two techniques? I know they have to do with extraction. But it seems like in some articles and conversations it is suggested that the two techniques might also provide different results. For instance, maybe the donor hair with FUE/FIT is better prepared to grow in the recipient area because of the way it is extracted? Does anyone know anything about this?

Also, it seems like the donor scar with the Strip is becoming a less and less noticeable thing (still noticeable I know) so that maybe that is a smaller issue. Not being able to have a close haircut in back I don't think is a concern of mine.

Should I be considering any other issues when deciding between the two different types of surgery? My thought process now is that neither type has a distinct advantage. The only two main differences that I see are the end results of the particular doctor and the price. Should I be consider anything else?

Thanks.

 

[Guest]

Chief,

Nice to see you're still hanging around reading these forums. You're questions are very legitimate because everyone has varying goals. FUE/FIT is not for everyone. Strip is not for everyone. Please allow me to expound on that.

The fundamental challenge for patients with male pattern baldness is that an extremely high percent of us progress with our hairloss over time and so we need/want upwards of 4,000 plus grafts which is a conservative estimate. For example, I am 51 and to date have 6,900 total strip grafts that were compiled in four seperate procedures. Being that many of us, if not all of us, want the best possible yields because our donor is limited, many choose strip over FUE/FIT. Keep in mind that the comparisons are based on competent surgeons performing the work.

To date, the microscopic dissection and preparation of grafts continues to produce the optimal best verified yields, clinically speaking. There continues to be a tremedous lack of published verified yields with FUE. The FUE technology has been around long enough now to accurately document the data. So where is all of it? In addition, you rarely if ever see pics or testimonials of the larger cases of 4,000 plus FUE extractions taken solely from the scalp. Obviously when you get into those higher ranges, the moth-eaten appearance begins to infiltrate the donor areas. Try buzzing your head to a number two or shorter having 4,000 plus extractions and you'll see exactly what I mean. This is especially true for guys with wide color contrasts, dark hair on a fair complected scalp and guys that tan very well. I have seen endless pics and in person visuals to know what I am speaking about. When the FUE technology really hit North America, there were massive promotions going on in many of the hairloss forums referring to it as a scarless technique. I still see it now and then and IMO it's totally marketing driven. DON"T BELIEVE THAT FOR ONE NY MINUTE! :freaked:

It probably sounds to you that I don't believe in FUE/FIT but in actuality, and as I said before, it has it's place. Well then IMO when would FUE be more appropriate or practical for patients? FUE is a great option for smaller cases whereby the extent of male pattern baldness in that patient's total family history is minimal. I have recommended FUE for those who want lower or more defined hairlines however they do not have male pattern baldness. They are doing it strictly for cosmetic enhancement. So obviously this includes women as well. FUE may be the "only" option for corrective situations including plug redistribution and filling in stretched scars, etc. I also recommend FUE for facial hair restoration such as eyebrows.

The recipient area is not treated any differently relative to the artistic attributes between FUE and strip.

If many of us could have it our way, then the financial considerations would not have to be there. But yet I know what you're saying when you compare the cost. If my 6,900 grafts would have been all FUE, the cost to me would have been approximately $55,000 US dollars. Actually, it would have been much higher because no one was doing FUE in the US when I had my first hair transplant. Would have had to flown to Austraila and seen Dr. Woods and pay the real big bucks. :shock:

 

[techprof]

Gillenator is the man.

Chief, looks like strip is the best for you considering the fact that you don't care about buzzing it too short in the back.

When I had my grafts planned with Dr. Arvind Poswal, I wanted to get out of it asap. So I chose strip instead of fue (one day as opposed to one week).

Also, as Gillenator has said I would like to see at least one picture of 4000 + grafts done on a NW5+ convincingly. If you are taking too many grafts that means that you have to keep the sides and the back hair longer with fue (the same is true with strip also).

However, I agree with Gillenator about fue. If I were NW2 (stable for 10 years or so) I would choose FUE to lower my hairline.

 

[Chief]

Gillenator - Thanks for the reply.

Some follow up questions and comments

Is there much evidence that the results in the recipient areas using FUE or Strip is better than the other. Again, I know it has to do with extraction but if I read comments that people say that the results of FUE are better than Strip because of the way it is extracted (or vice versa)

Also, I have read a lot in forums of people who say Strip "ruined their lives" because the scar looks so bad. Has the Trico Closure (sp?) technique solved some of this problem by leaving a "nicer" scar?

Do the top doctors do a better job with the scar to make it less obvious? Did a lot of the people with bad scars just go to bad doctors? For instance, have you heard very many complaints about scars from Hasson, Wong or Shapiro patients?

I am going to need a lot of donor hairs. I have read the strip will allow you the largest amount of donor hairs. I have also read where FUE will allow you the largest amount of donor hairs. Does one or the other allow a larger number?

I am fine with not having a buzz cut. I am 32 years old a Norwood 3.75 and will probably end up a Norwood 6. (although drugs may help me in the back a little)

Thanks for any replies.

 

[Chief]

Gillenator - Thanks for the reply.

Some follow up questions and comments

Is there much evidence that the results in the recipient areas using FUE or Strip is better than the other. Again, I know it has to do with extraction but if I read comments that people say that the results of FUE are better than Strip because of the way it is extracted (or vice versa)

Also, I have read a lot in forums of people who say Strip "ruined their lives" because the scar looks so bad. Has the Trico Closure (sp?) technique solved some of this problem by leaving a "nicer" scar?

Do the top doctors do a better job with the scar to make it less obvious? Did a lot of the people with bad scars just go to bad doctors? For instance, have you heard very many complaints about scars from Hasson, Wong or Shapiro patients?

I am going to need a lot of donor hairs. I have read the strip will allow you the largest amount of donor hairs. I have also read where FUE will allow you the largest amount of donor hairs. Does one or the other allow a larger number?

I am fine with not having a buzz cut. I am 32 years old a Norwood 3.75 and will probably end up a Norwood 6. (although drugs may help me in the back a little)

Thanks for any replies.

 

[Full Head of Hair]

Thanks for those replies Gillinator, they were very informative. Prior to ever loosing hair, at say age 12 for instance, my hairline was farther back on the right side. After loosing some hair almost completly on the right temple, it looks worse. The left temple is virtually unchanged, but the right is driving me nuts. I would say my left is naturally a Norwood 1.5 and still is. I would say my right is like a Norwood 2.5 and it drives me nuts.

So I sent in some pictures to Armani b/c that is the Doctor I want for my hairline repair. I was quoted at like 2300 grafts, which I think is a bit much, although i want my hairline really dense and thick b/c I want to keep spiking it up with a bunch of gel like I always have. In my estimation I would want , maybe 1500-2000 grafts to have a Brad Pitt hairline. I'm thinking this would probably be best if I went with FUE...

Anyway, what are your thoughts???

 

[Chief]

I have concluded (and I may be wrong) but that the FUE/FIT technology is over rated. I have personally seen a number of strip patients and their scars are either non factors and literally not noticeable (with 1/2 or so long hair). I literally dug through their hair and couldn't find it. Obviously if you want a buzz cut this may be a factor.

I do not understand why someone would pay twice as much for FUE/FIT over Strip. It makes no sense.

I will say this to show I am not bias. Dr. Cole is obviously on the front end of FUE/FIT technology and performs this type of surgery that I am saying is over rated. However, I personally saw a couple of his hair lines this week and I was AMAZED. Exceptional work. LITERALLY, did not believe his hairline was not natural. I have NEVER seen a better hairline.

I am curious as to some of the experienced opinions on this forum as to the FUE/FIT technology. I just don't think the scar of Strip is a legitimate concern anymore.

 

[Guest]

Thanks guys, and I mean that as humble as I can say it. It really is what makes me tick.

Please allow me to reply to the additional questions you have. First of all, it is my opinion, which is pre-empted and shared by many reputable hair transplant surgeons including several who perform both strip and FUE, do not "treat" the recipient area any differently regarding the artisticly created and properly angulated recipient incisions. Coronal and saggital incisions are just that. It is the size, depth, and angulation that can be varied to create varying visuals such as hyper-acute angulation effects.

For example, a competent surgeon who does both strip and FUE is undoubtedly going to utilize custom designed blades that accomodate the exact peripheral of the grafts being dissected "or" extracted. So if FUE is being done, and the surgeon is employing a 1mm punch, .70mm, etc, the blades used need to creates sites that will receive the graft tiisue on placement without the grafts pitting because the sites were too large and/ or cobblestoning effects because the sites were smaller then the grafts. We can potentially lose more grafts if the sites are too much larger than the graft tissue as well.

Let's talk about the scarring issues. Most patients that I have seen virtually "thousands" of pics and in-person observations, are relatively good healers and yes, with a competent hair transplant surgeon, the healed linear scar is very thin and hardly detectable. And with more trico-closures being done, it only improves the situation. Remember, as with anything else, trico-closures are not right for every patient, especially those with little to no scalp laxity. But generally speaking, most can and will benefit from that method of closure. And it obviously has presented more attraction to the strip harvest method when comparing strip to FUE. Anyone who does not heal well meaning, heals with stretched and/or raised scars such as keloiding, should really stay away from hair transplants altogethor IMO. :freaked2:

I would also agree that an extremely high percent of those who had their lives ruined with strip scars are those who went to the wrong docs. It's true that you won't find patients complaining about their strip scars from the top docs. I think that's absolutely amazing when you consider how many procedures they each do over the years.

Lastly, when you hear some say that you can get more hair harvested with FUE, the true implication is that isolated extraction techniques can reach areas of terminal donor hair that you would never reach or want to reach with a strip excision, especially the body hair.

If you have potential to be a Norwood 6, then management of donor as well as best achievable yields are critical to get the biggest bang for your limited grafts. Hope this clarifies some other concerns you have. :wink:

 

[Guest]

Full Head of Hair,

Glad to be of help. Can you tell me more about the most extensives class of hairloss in either side of your family history?

I would also first get a good estimate in how many harvestable grafts you have including future procedures you will need in your lifetime. I trust you are on hairloss meds to minimize your progression of male pattern baldness. We really should plan our restoration from a worst case scenario, and then if the meds continue to work over the long term as they have for me, you can always add later. I am up to 6900 grafts now in my lifetime, but I don't think I will be able to do another strip because of laxity issues.

I know the graft range may say sound on the high end however whenever there is hairline work done, many single hair grafts are used.

 

[DaveOne]

A couple of things:

FUE is really only 3 years old or so in N America. The only docs that I've heard of doing it on a REGULAR regular basis w/ any proficiency are:

Wolf
Cole
Rassman
Bernstein
Umar
Harris
Feller


There maybe be some more, but you get my point..it's only a handful compared to the strip industry, and very few have dedicated their clinic to it, as it's more time consuming/labor intensive and requires innovation. The techniques are still being refined, whereas strip has been pretty stable for awhile.

There are probably hundreds if not thousands of strip docs and strip has been going on for over a decade now. So with these small clinics performing FUE, it takes extra effort and money to do real studies. Harris did one awhile ago I believe. Maybe Bernstein too? I know Cole is working on one now or might have finished with a yield study recently. Anyway, the technique is still in its infancy..I'm sure more studies will come, but it takes time. Several books, publications, and studies of strip exist because it's been around for over 15 years, and hundreds of thousands of strip jobs have been performed over that time.

As far as FUE, there are some cases of 3-4k fue, you just have to look for them. I'll try to dig up a few later. I will say this about the scarring- if you shave your head, you will see both FUE scarring and strip scarring (obviously). But if you go to a 1 or 2, the strip scar will be more detectable in most cases than FUE scarring done by a good Doctor, because the FUE white dots are in a random pattern, and become much less detectable when the hair grows out even a little bit. The reason is that the eye will perceive a linear change in hair direction more readily than random small gaps, as hair has gaps in between anyway. But a strip scar distorts the hair growth direction. If you grow your hair out to a 3 or 4 guard and don't want to ever cut it shorter, then maybe strip is the way to go, assuming your donor doesn't thin out too much, in which case you shouldn't get hair transplant anyway. I think strip is a good way to go for an older guy with stabilized hairloss who wants to get as much hair as possible in one shot and save money AND doesn't ever want to cut his hair really short. I think strip is a HUGE gamble for the younger patient.

 

[Follically Challenged]

All Dr. Jones in Toronto does is FUE.

 

[DaveOne]

Absolutely..I totally forgot to mention him. I was just going from my immediate memory. Speaking of which, I haven't heard a thing from him in awhile.

 

[Future]

gillenator,

I am quite impressed about the quality as well as the quantity of your reply - informative, balanced and quite descriptive! Good stuff...

Since you've had 4 strips done I was wondering whether you feel any numbness or any other problems that have been caused by your hair transplants.

From what you've also written I understand that there are different techniques for planting the grafts into the recipient area: coronal, saggital incision no matter whether Strip or FUE is being used. Correct?

I also understand that it is crucial that the holes created in the recipients area are neither too big (this might hairs stop from growing?); or if the holes are too small this might them pop out of the scalp or leave bumps, correct?

Finally, it would be interesting to know whether the trico closure makes the scar really invisible - or just less visible? Has anybody seen pictures of people with trico closure?

 

[Chief]

I am not Gillenator but it is my opinion that the trico closure makes the scar LESS visible. This was a concern of mine as I am preparing for surgery but I now have ZERO concern about a Strip scar after seeing the scars from the top docs. I literally have trouble spotting it even digging my hands through their heads. ( I have seen Dr. Cole and Dr. Shapiro's patients)

Gillenator - Can you email me at messages60657@yahoo.com? Thanks

 

[Guest]

Future,

Thanks for the vote of confidence. You know my numbness from my recent sugery two months ago is dissipating with time. It usually takes me 9 to 12 months to regain complete feeling, no big deal.

Yes, the recipient incisions have nothing to do with how donor hair is harvested by strip or FUE.

You are also correct that too small of recipient sites for the grafts can promote cobblestoning effects and sites too big can cause cratering and/or pitting. That's why custom made blades are used by the best docs to accomodate the peripheral diameter of the grafts cut to size.

You can find some pics of tricoclosures on the other forums like Hairsite and the HTN.

 

[Future]

gillenator,

do you have 4 (parallel) scars from 4 surgeries then? I can't imagine that you still can hide something big like this. Or am I wrong?

Apart from that I thought that 3 strips would be the utmost as the flexibility of the scalp is limited.