Is it best to have strip surgery first, then fue to maximise the donor harvesting of grafts, or vice versa ? .............................. A question that when one starts to research is not far on the list to decide and debate.

There will always be debate over the techniques, either patient to patient or clinic to clinic. They both have pros and cons and it is a hard question to really give defining answers to, so maybe better settle on a simple get out, it depends on what you need and what your donor can afford, of course with long term planning always in mind; so assuming both are performed to a high standard.

FUE or Follicular Unit Extraction is obviously more welcome for smaller procedures if only because it will not leave a linear scar so still allows the person to keep their hair shorter than strip could and even shaved. FUE becomes harder to advise the larger the session, either because of potential limits to harvesting so many grafts individually in one session or the impact it may have on the safe donor area again removing so many individual FU from a surface area that does not change and still leave the donor looking natural and not thin.

Strip is obviously great for larger sessions and high NW cases when maybe FUE cannot safely reach the numbers in one session or even multiple sessions, and Strip can give the person much greater coverage quicker. OK, it leaves a linear scar but then no one said HT is all good and there will never be any visible signs of surgery, and most guys can accept this for the trade off of much more hair. Strip with Trichophytic Closure has the benefit over FUE that the area the hair is taken from is actually removed so the donor density is not as such effected, yes the laxity will alter slightly but not to the point more cannot be taken in the future. Because the area of extraction is concentrated generally more grafts can be taken in one session compared to FUE.

Stephenl, one time patient of BHR and now a Senior Patient Advisor opted for FUE, and was a NW5/6 but had a much higher than average donor and even still is relying on BH to finish his crown. Stephen decided on FUE because he wanted to be able to shave still, something he couldn't have done with Strip. But if he didn't care about shaving he could have completed his restoration a few years ago, with less ops, rather than multiple smaller FUE;s; one big Strip to start with probably giving him the same as 3 FUE sessions did. So, it is all about what you have in your donor, what your goals and intentions are and the future, both are good techniques and used well and can combine well also.

So, Whats the average donor supply of a person in the nw3-5 range?

Obviously the average donor is going to change dependent on the person's genre and hair characteristics, but we base an average density around the 75 follicular units per cm2 mark, 80 and above being good and 60 being poor and potentially not a candidate. Then there is the approx amount of hairs per FU, skin laxity to address also.

To max the number of grafts on most candidates it is best to go Strip first if the pattern of hair loss is high and a lot of grafts are needed. With good healing of the suture another Strip could then be taken, smaller than the first and then FUE at the same time or later, probably still leaving room for another smaller op or two with good planning and harvesting of the grafts.

If the density is very high then FUE can be used and continued to be used and still get a meaningful amount from a Strip later, so if the hair loss pattern is still relatively minimal and FUE is preferred under the circumstances then do smaller FUE sessions as long as the harvesting pattern is well thought out, this will minimise the density loss to the donor and enable a decent Strip if the pattern of loss increases dramatically in the future.

Over harvesting with either technique can be a problem, the skin laxity changes with every strip so the position of the suture is important, taking it in a safe area where even with aggressive hair loss it will not be visible, but also with FUE; over harvesting will thin the donor and leave it see through, and this could expose the suture line area or leave an unbalanced appearance of density around the donor if not harvested correctly.

So, How many Strip surgeries can I have, 2,3 more?

It's not really as simple as that because you have to look at the hair groupings, the laxity of the skin, there are many variables to think about. You have to question where each strip will be removed from, the length and width, would it be possible to remove the strips from different areas of the scalp or would it mean englobing each one, thus effecting the laxity more. Every time a linear cut is made, and dependent on the technique used by the doctor is it going to impair the skin healing and laxity, so this will have a knock on effect for future procedures, especially as the Strip safe zone is relatively limited in size, that is unless you start taking the strip from different angles and positions.

Multiple strips is obviously possibly but the amount that can be taken per strip over time is harder to assess. Also there is the question why do relatively small strips that will leave a linear scar when FUE is probably more suitable if around 2000 grafts is required, especially if the example has average to good density.

It may also be possible to utilise FUE and even leave a band of virgin scalp in the donor for later use of Strip if the hair loss progressed and required a larger procedure. This is possible with smaller FUE procedures and maybe worth doing with average density donor as it gives an uncorrupted Strip zone with original density.

This all comes down to planning from the first op and you and the doc being on the same page, obviously a personal consultation is had before, or at least very good educational dialogue between clinic and you to thrash out the possibilities prior to the day, and then on proper assessment the choices and reasons are already known and understood. Always remember, talk to previous patients and see their results in person if you can, this will tell you much about the doctor's work and how he thinks.