Graft yield/survival/wastefulness FUE vs FUT

[GoldenMane]

I know FUT has the potential for greatest graft yield in a single session, but I mean, which one has the best follicle survival rate? When a strip of tissue is removed via FUT, its my understanding that 10% of the follicles in that strip are in a dormant stage, and since these are invisible, they aren't transplanted and merely lost, then there's teh issue of transection of follicles towards the edge of the excised area. And finally there are the grafts that don't survive transplantation which I believe even with the best surgeons may be as much as 5%, in worse surgeons, much, much more. So that's potentially a lot of follicles wasted.

But what about FUE? There's the risk of transection with every follicles removed. But the follicles in a dormant phase aren't excised so they aren't wasted (unless transected. I'd imagine survival rate post follicle removal and implantation would be pretty similar.

So which one wastes the fewest number of hair follicles?

 

[shookwun]

FUT has greater survivaal rate, and quality grafts.

With FUT harvest from the mid donor zone where most the hair is permanent. IN Fue Grafts are taken all over, and in areas that are more suspect to thinning over age, and time.

Grafts are more fragile, and prone to damage during extraction of FUE. More handling, increased risk.

FUE leaves thousands of micro scars all of your scalp where as FUT is just one linear scar. Even when another FUT is done, it replaces the old scar, and the patient is always left with one scar. Scar can be grafted or have SMP to camouflage.

FUE does generally has less yield, because of it being harder to capture the entire graft with a pinch. A 3 follicle could turn into a 1 follicle when punched out during dissection. Where as FUT is linear, and the strip has a protective dermis, and surrounding tissue that is easily separated by the technicians. Maximizing higher graft hair counts. 2,3 and 4's

FUE is good for smaller end procedures, but FUT is still the anchor for hair transplantation.

 

[GoldenMane]

Well what is the threshold past which you should switch from FUE to FUT? 1000 - 2000 grafts? 1500? 1800?

Also is the difference significant? Given that FUT would lose minimum 10% of follicles due to them being dormant, as well as additional follicles due to transection at the edge of the excised area, and losses post transplantation, that must mean that the follicle/graft losses due to FUE must exceed 15%... That's quite a lot of hairs to lose in an FUE procedure...

 

[arfy]

We only know what doctors claim to be true, and they have a vested interest in making yields from their procedure seem good, and other procedures' yields seem worse.

If the doctor is great at doing FUE, then yields should theoretically rival strip yields. However, I'm not convinced that there are an abundance of great FUE doctors. It seems like lots of doctors are jumping on the FUE bandwagon, but don't really have the experience yet. The problem is that if you have a reduced yield, you might never know, except one day you run out of donor hair (which everybody does) but you've fallen farther short of your goal, than if you would have had an efficient yield. The difference after several procedures could be thousands of grafts lost, in the end. Even the doctor might not realize it (unless he can see that he's screwing up the excisions, but of course he won't say anything). And by the way, not everybody is equally good at removing the strip and dissecting the grafts, either. The flip side of "plump" FUT grafts is 'too much' excess tissue per graft, potential graft compression, issues with being seated perfectly in the scalp, etc (bumps or divots). As well as additional transection along the donor area (some doctors still use multi-bladed knives to harvest a strip, for example, which wastes more hair).

This is an ongoing debate. Efficiency and survival is a key issue. A lot will depend on which particular doctors are being compared, what the individual's hair characteristics are (some guys are easier to FUE harvest than others), and so on. And in the end, you still have to go on faith that the doctors don't have an off day, there's no new trainees on the staff, etc.

 

[GoldenMane]

Well since it's mostly down to doctor skill, it seems I have made a good choice in Dr de Reys. From what I've read, he gets about 90% FUE survival rate (rivalling good FUT surgeons) and does so because he personally removes and places the grafts (maybe Fred can vouch for this?) and takes his time, removing only 1000 grafts, and has only 2 patient per day. A slower process, lower yields per day, but a higher grafts survival rate sounds like just the ticket. Hopefully he doesn't have an off day with me!

 

[Swoop]

FUT has an edge over FUE, simply because one doesn't have some supernatural x-ray vision while punching out grafts with FUE. With FUE the damage variability to the grafts will be higher.

There is no scientific answer to though because of too many variables. That being said in a elite FUT vs elite FUE practitioner scenario I personally think the edge for FUT over FUE is small.

 

[GoldenMane]

FUT has an edge over FUE, simply because one doesn't have some supernatural x-ray vision while punching out grafts with FUE. With FUE the damage variability to the grafts will be higher.

There is no scientific answer to though because of too many variables. That being said in a elite FUT vs elite FUE practitioner scenario I personally think the edge for FUT over FUE is small.

Yeah, I can see that... Makes sense. But if Dr De Reys can get a 90% yield by taking his time and taking less grafts per session then that's a pretty good yield then that's comparable to a good FUT yield. I understand that many FUE surgeons get yields of about 75% or less I'm basically just worried if I made the right or wrong choice in booking a FUE surgery over FUT... But I think I made a good choice with Dr Reys in that regard considering my worries over yield and his take your time approach. I have fine hair which means less overall coverage and more grafts required per cm2, conserving donor hair is paramount...

 

[arfy]

FUT has an edge over FUE, simply because one doesn't have some supernatural x-ray vision while punching out grafts with FUE. With FUE the damage variability to the grafts will be higher.

Good point. Nobody has X-ray eyes. FUE yield would be improved if there was an imaging system that could 'sense' the follicle structures beneath the skin.

Is it true that Dr. de Reys does the procedure himself without using techs to do extractions and placement? If so, that is a very good thing.

Dr Cole claims a very low transection rate (2% or something like that). However that's undocumented - you have to take his word for that, and Dr Cole is certifiably unethical (paid large penalties to two state medical boards for ethics violations) and he's willing to lie when it benefits him.