Dots vs lines: scarring after FUE and best/worst case scenarios.

[bismarck]

The crux of the FUE/FUT debate seems to come down to scarring vs yield.

Edited September 21, 2014 by bismarck

[Mickey85]

From what I have read, the PCID is not vacuum powered, the grafts themselves still have to be removed manually via forceps. Information on the PCID is very scarce partially because the actually designer of it is quite secretive about the device.

[1978matt]

Lastly, does anyone know what closure technique Konior uses? His patient submitted cases typically seem imperceptible, although most are not shaved down enough to tell that well.

 

It is trichophytic with deep sutures and staples. From what I have seen most people have the staples out after 1-3 days, the sutures 10-12 days.

[gillenator]

bismark,

 

Very good questions and topic. The first and foremost thing we all need to keep in mind is that the multifaceted biological and genetic differences between individuals carries a lot of weight when it comes to how the body repairs itself and how the scar comes out. Now and then, all doctors and clinics get the patient(s) who may be more prone to scarring or heals with pigmented or raised scars.

 

You referred to a genetic disposition on your father's side which shows he is a good healer and undoubtedly has a strong auto-immune system. So yes, that can definitely work in your favor except that you also have maternal genes that your father does not. That's not a negative implication, just making a point.

 

But let me speak in general terms. The reason that FUE had developed an occasional bad reputation for scarring was back when most of the docs in the world were first learning the technique. They were using much larger punches, had much higher rates of transection, etc. Prior to that only one HT surgeon in Australia who really is the grandfather of FUE was doing it with any consistent success, meaning, minimal scarring and good yields.

 

But FUE has come a long way since that time roughly a decade ago. Present day, there are a number of surgeons preforming FUE with consistent results including optimal yields. And I am referring to Europe as well as North America.

 

IMHO, FUHT still produces some outstanding results and cannot be denied. Both methods have their place. FUHT in the right hands still produces a very high level of yield and if the doctor chooses the right closing technique that is appropriate for the case/patient, and they have no issues with healing, then the strip scar will come out very thin. Does that imply that the patient will be able to buzz down to a number 1 or 2 guide? That cannot be answered with a simple yes or no answer because it depends on the individual. Let me explain.

 

Closing techniques do not necessarily guarantee the outcome of the strip scar. In other words, using staples rather than a double closing method will not guarantee that the scar will be thinner or less detectable. It is more probable that it will in those cases where the laxity is less than desired for a larger strip taken, but again, the physiological attributes of the patient is what usually determines the outcome in how the scar heals providing the closure is done adequately and competently.

 

So IMHO, the argument of which method is better is not the real issue. The better question is, "Which technique is better for that particular individual considering all facets of the case which includes the individual's goals and the potential for more hair loss over their lifetime".

 

Take the individual who has no advanced classes of MPB in their family history, has adequate density and realistic goals. That case has a great profile for FUE. On the other hand, take someone who has more potential for far more loss, has no aspirations to wear a buzzed cut hair style, and has no healing issues, has good donor density, then FUHT may be the best option for that individual.

 

In my own case, FUE was not available back in 1996 when I had my first FUHT procedure. I went to a renowned surgeon back then and my strip scar came out very fine and thin. Since then I had another 3 FUHT procedures for a grand total of roughly 7000 grafts and never intend to wear a buzzed or short hair style. My last procedure was done in 2006, even when FUE was on the rise but again, I do not like short hair and already had a strip scar. I still only have one long strip scar but it is still very thin and virtually undetectable as I wear my hair length at least 2 inches in the donor zone. I also have a limited budget.

 

So for me, FUHT was the only way to go. If I had the chance to do it all over again, I would still choose FUHT. But that's for me and not necessarily for someone who has a completely different profile than myself and may have completely different goals.

 

As long as you understand the benefits as well as the short-comings of either technique, then you and only you can decide what's best for Bismark based on your own potential for future loss, your own donor limitations, and your life-long goals...

[BUSA]

haven't seen any poor FUE scaring in years now. it just doesn't happen with any decent recommended FUE surgeon any longer.

 

years ago u wud see an occasional case of poor FUE scaring from some idiot who was experimenting on a patient who didn't know what size punch to use or was just unskilled in general. its not even a topic of debate these days any longer with skilled FUE doctors.

 

the whole FUT will produce a greater yield is a thing of the past. FUE doctors are producing between 90-95% yield. if ur lookn to shave ur head down at any point in ur life u can forget FUT.

 

no doctor has a crystal ball to predict how u will heal wen carving a huge chunk of flesh from the back of ones head.

 

there are so few cases these days that FUT wud be a better choice for. I wud say its rare. very rare. nearly ALL HT's these days can be performed with FUE. and performed better cause there is zero chance of a stretched out scar.

 

most everyone that has had FUT will say FUT is the better way to go. well, those that weren't left with horrible scaring will say that. those that have had to seek out an FUE doctor to repair their FUT scar obviously will have a different opinion but u won't find ONE single patient that has had FUE and is now seeking out an FUT surgeon to repair him will you?

[1978matt]

Despite what the uninformed/uneducated say, FUE is not for everyone. The average person may only have 4,000-5,000 FUE grafts and depending on hair characteristics this may not be enough to address a lifetime of significant balding. Once the donor area has been tapped out you also lose the option to have FUT surgeries since the scar would be too visible.

 

When it comes to FUE some peoples follicles extract poorly which leads to transection and other damage such as crushing or twisting. Whether this is likely to happen in your own case can only be determined through an examination of your donor area by a doctor experienced in FUE. If this is not taken into consideration then it's possible that more damage will be done to the donor area since more extractions will have to be performed in order for the surgeon to get enough 'viable' grafts for you surgery. The knock on effect is that your donor gets even thinner than originally intended. Even the great FUE surgeons will not guarantee more than 85% yield.

 

My view is that 2,000 grafts FUE is a reasonable way to start out. A young guy would not have to commit to a strip scar and if he were to lose more hair he could cut his losses and move on. On the other hand, if you end up needing more hair in the future it might be the time to consider switching to FUT is it is likely to provide you with more lifetime donor hair.

 

Of course if a guy has poor laxity then FUT may not be an option at all.

[Spanker]

There are a lot of good points in this post. Pcid is not a vacuumed device. Dr. K usually does a combination on sutures and staples. Type of closure depends on the case. I was fairly young and I think he saw another case in my future at some point so I didn't have a trichophytic closure. My scar is extremely thin but I have not shaved lower than a three.

 

I think there are concerns other than scarring when deciding on which procedure to go with, like how many grafts you are going to need, your laxity our lack there of, the density you bring to the table, etc. I disagree that there has not been poor fue scarring in years. Also, I done see very many people shaving their head super tight after a successful fue procedure.

 

I believe they both have their place. I honestly don't know that I would have done anything different, but who knows. Fue has come a long way just in the last three years, but, I still think your goals and what your body brings to the table will be very important when choosing what procedure is best for you.

[gillenator]

bismark,

 

One thing that you can do is to have a smaller trial session of FUE to see how the yield goes.

 

Although it is true that FUE has been greatly refined by a smaller number of surgeons, those who have more potential for the more advanced classes of MPB will want to be careful choosing FUE unless the individual has above average donor density. This is not favoring one technique over the other, but as many of us have already stated, there are many varying attributes between individuals.

 

Anyway you look at it, having 5,000 or more FUE extractions will have a bearing on the appearance of the donor region when buzzing down to a number 2 or lower.

 

We have to remember that HT surgery is a trade-off between having hair in the areas we are losing it to having a visually compromised donor area, be it FUHT or FUE.

 

But as was stated, most guys that have large sessions of HT surgery end up growing their hair out. Very few end up cutting it real short. That's the reality of it and you can't really appreciate that statement until you actually have the procedure and experience the regrowth and end result...

[Loags79]

I'd much prefer a linear scar to get high yield. I wouldn't do because my donor area will look very mangy and sparse dues to my hair characteristics. For others with different goals or hair characteristics FUE could be a better option.