Why we don’t offer FUE procedure?

Why we don’t offer FUE procedure?

Because we don’t think it’s your best interest!

Don’t listen to what people tell you! Take sometime, do your study seriously, ask questions, use your own intelligent and make your own decision.

Differences between FUT and FUE:

The only different between FUT and FUE is donor harvesting.

FUT uses blade and FUE uses punch. The recipient site transplant are completely the same.

Different tool used produced different result!

Comparison	FUE	FUT
Is it the latest technique?	no, it is the oldest punch graft but change the size of punch
Tool	punch	blade
Donor harvesting	blind	under direct microscopy vision
Wound treatment	leave open	closed
Scar	thousand of small punch scars	one linear scar
Scar distribution (in same length)	5 to 6 times wider	one line only
Total Scar Size	10 times bigger
Scar long term effect	permanent	permanent
For keloid patient	disaster-hard to treat thousand keloids	easier- only one scar to treat
Quality of graft	defect graft (no tissue around follicle)	intact graft (come with tissue around follicle)
Growth rate of transplantation	61.40%	86%	Read Dr.Beehner's study
Impact to 2nd surgery	huge-scar tissues change the hair direction	minimum- can use different donor area
Length of hair need to cover up the scar	1 cm	2 cm
Hairstyle options such as marine cut	no	yes
Price	Double

Why most surgeons prefer FUE?

  

FUE: need only one technician

FUT: need 3-4 technicians

Some surgeons do everything by themselves without hiring any assistance to save on business costs. It is for their own best interest, not yours.

In addition to the overhead expense, the surgery fee is double for the FUE technique. The incentive using FUE for physicians are simply irresistible. Especially for new physician who’s just starting his practice with only 3 to 5 surgeries a month. It’s difficult to start a business when you need to hire 3 to 4 technicians to assist.

ISHRS Warning

Learn from one hair transplant surgeon’s own experience.

FUT Scar

Our FUT Scars

FUT Donor Scar-Videos

You can barely see the donor scar from the videos.

FUT Scars

The scar on the donor site is nearly invisible with with Trichophytic Closure.

These photos below are taken on the suture removal days (10 days after surgery)

Invisible FUE Scar?

There was one young gentleman sitting in front of me on the airport shuttle.

I was looking around, and all of a sudden, I saw thousands of small round bald spots at the back of his head. I realized immediately that they are the recently popular FUE scars.

The size of FUE punch usually range from 0.8 mm to 1 mm. It is assumed the scar would be the same size, but the fact is that the scar always grows bigger than the size of the punch. The more tension of the scalp the bigger the scar. 

People spend 2-3 times the surgery fee and transection rate is much higher just to have the option to have a short hair cut. However, they really don't have option to shave their head. If their barber cuts their hair too short then they will be bothered for weeks before hair grows long enough to cover the scars. At the same time, it is a big problem for their barber too, they don't have any idea how short they can cut without the scars showing. 

Under direct sunshine requires much longer hair to cover then indoors, which is the standard they should perform.  

Attached are two photos which I used an  Iphone to take.The shuttle was very jumpy, hard to focus on.

No Linear Scar, New Approaches!

You don’t like to have a linear scar at the back of your head.

FUE is not the only option anymore.

We have new approaches:

1, FUT+FUE approach
We can use FUT method to transplant as many grafts as needed (at the 50% of FUE cost ). With the Tricophytics Closure technique, it will ensure a fine scar. After 6 months if you don’t like the fine scar we can transplant 100 to 200 FUE grafts onto the scar to make the scar invisible.

2, FUT+FUT approach
First step as above but instead of using FUE graft to cover up the scar, we can cut only 2-3 cm strips to use as grafts.

3, FUT+TATOO
This approach is much easier.First step as above but use tatoo to make scar invisible.

Advantages of these approaches compare to total FUE (no linear scar from all approaches)-

1, Much better result. Grafts quality is much better to cut under microscope direct vision then blind FUE extraction.
2, No extensive shave at donor site during the surgery.
3, Leave only 100-200 small punch scars compare to thousand scars left from total FUE procedure.4, Save thousand and thousand surgery fee.

Disadvantage-You may need second minor surgery. But anyway, FUE procedure always needs more than one procedure too.

Short donor hair

Even with short hair, we can cover the donor site, but it is still visible to the naked eye. This is 3 days post op. We prefer the donor hair to be at least 3/4 inch in length. The donor site availability is limited when the hair is too short, because we prefer the hair to be long enough to cover the suture site.

Question: Do I need to come back for suture removal?

Question: Do I need to come back for suture removal?

Answer:

At NHT Medical Center we use a polyglactin 910 suture to close the donor area. I prefer using sutures to staples because they are more comfortable for the patient and result in a less noticeable scar. In addition, these absorbable sutures begin to fall off on their own 7 to 10 days after surgery as the wound heals. The patient does not have to return for suture removal saving him a trip back to the office.

This photo is of a donor incision five days after surgery. At this point you can no longer see the suture.

An article in the 1999 Journal of the Canadian Dental Association reported on the advantages of the polyglactin 910 suture compared to staples. In the survey, researchers evaluated 42 patients with scalp wounds from cosmetic surgeries. They closed half the wound with the irradiated polyglactin 910 vicryl rapide fast-absorbing suture and the other half with traditional staples. In the study of these 42 patients they found:

· No inflammatory reaction in the areas closed with the absorbable sutures compared to 1 case in the wounds closed with staples
· An average pain score of 1.82 reported by patients for the sutures compared to average pain score of 6.7 for the staples
· No patient reported suppuration, hypertrophic scarring, or alopecia with either method
· All 42 patients in the sample preferred sutures to staples

Scalp Stretch Exercise

To have the best scar and widest donor size possible, we strongly recommend you to do the Scalp Stretch Exercise twice a day, 60 repetitions per minute, ten minutes each time.

Why We Don't Use FUE

When Dr. William Rassman first presented the Follicular Unit Extraction (FUE) method in 2002, almost every hair transplant surgeon criticized it as it taking us back to the old punch age. The FUE punch measured 0.8mm in diameter, much smaller than the 4mm original punch, and caused more transection than the older technique.

Over time Dr. Rassman convinced some surgeons to use his method. Dr. Jim Harris then improved the FUE punch to reduce the transection rate.

Let's evaluate the pros and cons of FUE.

The advantages of FUE:
1. No linear scar/minimizes scarring
2. Can use body hair as donor hair
3. Better for smaller surgeries (i.e. eyebrows, facial hair, touch-ups, scar cover-up)
4. For limited donor hair availability
5. For persons whom would like to wear their hair short


Rebuttal to Advantages:

#1-No linear scar does not mean no scar at all, it still leaves hundreds even thousands of small, round scars, whereas with the trichophytic closure method (discussed on 1/30/07 - Hair Can Grow Through Donor Scar), the linear scar is almost invisible.(as picture below)

#2-In Dr. Rassman's New Hair News volume 12, 2007 comment on body hair transplants, he stated: “in the live patient viewing, one doctor presented two patients who had body hair transplanted into the scalp. The aesthetic impact was negligible fuzz on the top of the scalp…Based upon what I saw, the value of body hair transplants to the scalp may only have experimental value in today’s surgical practice.”

#3-A small area such as eyebrow needs 300 to 400 grafts. With the strip method, we need a linear donor skin of 1 cm in width and 5 cm in length. When the hairs are shaved, it will show a 5-cm long fine scar. With FUE, it will show 300 to 400 small punched scar. Which scar looks more natural?

#4-With limited donor hair availability the small scars are even more visible.

#5-Extremely short hair leads to the possibility of FUE scars and linear scars being visible. Patient cannot shave his head with either procedures.

Further disadvantages of FUE:
1. Price
2. Time in surgery

FUE costs 200-300 hundred percent more than the strip harvest method and requires more time in surgery. I know one surgeon in Australia who takes one week to finish one patient. Is it worth the time and money?

Further disadvantage of FUE( compare to strip method)

*Quality of grafts can't compare this strips method.
FUE is blind punch method, strips method is cutting under microscope direct vision.
Which way will produce better guality of the grafts? And better result of regrowth?
* When hair loss progress, FUE patients will be converted to strips method's patients.
* After extensive FUE procedure, because of scars and lower density. The result of strips
method will be discount.

One hair transplant physician states that, "I have practiced FUE for the past five years. Most of my cases are strip FUT, but I perform an average of two FUE cases per week. Unfortunately, there are unscrupulous practitioners who advertise FUE as a scarless surgery and, therefore, many prospective patients present requesting FUE out of this expectation. Patients must understand that there are punctate scars. Granted, they are not visible when FUE has not been extensive, but can be readily detected when harvesting has been extensive and donor hair worn very short."

Hair Can Grow Through Donor Scar

Since Dr. Mario Marzola presented Trichophytic closure in the 2005 July/Aug ISHRS Forum, (Dr. Patrick Frechet also presented a variation of the technique), the appearance of donor scars have been improved significantly. Now hair can grow through the scar.

This photo shows the scar on the donor site (shaved for purpose of picture taking). You can see that there are hairs growing on the red scar area.

If you keep the hair long, the scar is nearly invisible. (Click on photos to see enlarged images)

It is one of the most important discoveries in hair transplant history.

Previously, the hair transplant patient may have wanted to use the same donor area on the second surgery to remove the scar from the prior surgery. However, if we use the same donor area (where the scar is), we harvest 20-30 percent less donor hair. The density in that area was already reduced in the first surgery.

Now with Trichophytic closure, since the scar is not ugly, there is no point in using the same donor area anymore. If one needs a second surgery, we can use a new donor area.