Excellent website. I have a question about FUE and strip surgery. I have read on forums and other hair loss websites that say its better to have a FUE transplant first if it is your first time getting a HT done rather then doing strip surgery. The strip method should be saved for any additional surgery that is needed or if you can in a second time. For some reason, they didn’t specify what type of surgery to get based on the size of the balding or number of grafts needed. I have read on this website that the larger the balding area the better it is to do strip because you can take out more grafts.
I am contemplating getting a surgery done, however, I am worried in the future my balding will progress and if I have to shave my hair in the future I don’t want a ’smiley face’ in the back of my head. Not to mention, if I need additional surgery and do choose to do strip again for some reason, I don’t want two smiley faces on the back of my head. I also wanted to add, I am 30 years old and have temple recession and a little thinning on my hairline and mid scalp. I know I will need a surgery in the future. I am on propecia so the crown has been holding well.
For less extensive balding patterns in the Norwood class 3 range, either FUE or strip will get you where you want to be. If you start with FUE for a class 3, then you should finish with FUE. The choice here may be price of the procedure, as FUE is generally more expensive. The bond with the doctor you link with is also a factor. For the advanced balding patterns (class 5, 6, and 7), extensive harvesting with strip surgery is well understood with considerable experience in the hands of most surgeons. The FUE technique may not get you the yield in the 7,000+ graft range typically harvested with extensive restorations in some of the advanced balding patterns. I am assuming that the surgeon does not go outside the permanent zone for additional donor grafts.
For a graft yield in a Caucasian male, 5,000 - 8,000 follicular units may be an upper end for donor supply in FUE. The yield goes down in Asians and Africans, as the density is lower in these races. These numbers were calculated as follows:
The permanent zone contains 25% of the original hair. In Caucasians birth hair numbers are 50,000 follicular units, in Asians it is 40,000 follicular units, in Africans it is 30,000 follicular units. For FUE, the doctor can harvest no more than 2/3rd of the follicular units safely in the donor area in a Caucasian (that is 8,250 follicular units). If the density is higher than average for that particular individual, then the numbers can rise. For example, if a person is born with 60,000 follicular units (not uncommon in a Caucasian male with higher than normal density), then the surgeon may be able to harvest over 10,000 FUE grafts. That requires a high density birth hair presence which is present in less than half of Caucasians, rarely in Asians, and almost never in African hair type individuals.