Two and a half years after 2,900 FUE grafts, crown's now going. Surgeon wants to do STRIP for round two. Isn't FUT the old way?

Regulars know the history: Norwood 3, 2,900 FUE grafts in early 2024, hairline and front, delighted with it, I'm the one who's always banging on about choosing a surgeon not an acronym. Well. The crown has started doing what crowns do, and I went back to the same surgeon last week assuming I'd be booking another FUE.

He looked at the back of my head under the magnifier thing for a long time and then said he'd rather do a STRIP this time. His reasoning as I understood it: my donor density is "average, not generous", the first FUE already took a spread of units out of the whole safe zone, and a strip from the densest bit in the middle would get him the 1,800 or so he wants for the crown without thinning the sides any further. He also said something about keeping FUE "in reserve" for later which I didn't fully follow.

I trust him. He did a good job the first time. But every forum, every clinic website, every YouTube video says FUT is the old method and FUE is the modern one, and here's my guy suggesting I go BACKWARDS. I also quite like that I can currently clip my back and sides to a grade 2 with nothing showing, and a strip scar ends that, doesn't it?

Is he behind the times, or is there a reason a second session is a different conversation from a first one? Anyone here had FUE first and strip second?

Not behind the times. Two of the best-regarded surgeons I looked at before mine still do strip for exactly this situation, and the thing that made me trust them was that they offered BOTH and picked per head, rather than owning one machine and selling one method. "Old" and "wrong" aren't the same word, and the people calling FUT dead are mostly the ones who don't offer it.

Different situation but the same conversation came up in my quote hunt. One of my three clinics said flat out that if I ever wanted the crown done after the front, they'd want to talk about strip for it, because at Norwood 5 my total donor budget was the whole problem and the strip "spends it more efficiently". The other two never mentioned strip existing. Guess which one I trusted more on the donor question.

The grade 2 thing is real though, and I'd want a straight answer on how wide the line usually ends up in his hands.

Ben, your surgeon is describing standard practice for a second session in an average donor, not a step backwards, and the reason it sounds odd is that the marketing has turned a harvesting choice into a badge of modernity.

The direct answer first. FUE and FUT produce the same grafts, the natural 1 to 4 hair follicular units, and once placed they grow the same way; what differs is how the donor is harvested and what it leaves behind. FUE takes units one at a time with a 0.7 to 1.2 mm punch, spread across the whole safe zone at a density commonly kept to around 10 to 15 excisions per cm2 so the thinning is invisible. FUT removes a strip about 1 to 1.5 cm wide from the densest part of that zone, the area is closed with sutures or staples, and the strip is dissected under magnification. The consequence your surgeon is weighing is that each FUE session lowers the density of the entire donor band a little, whereas a strip removes a narrow slice and leaves the density either side of it untouched. In a donor that started at roughly 65 to 85 follicular units per cm2, which is the typical safe-zone range, and has already given up 2,900 units to FUE, a second wide FUE harvest is where the sides start to look patchy under a short clip. The strip avoids that, and it also leaves un-punched scalp above and below the line that FUE can harvest years later if a third session is ever wanted. That is the "in reserve" remark.

What it costs you is precise and you have named it. A linear scar, typically fine in good laxity and good closure, but permanent, and hidden by hair rather than by absence of hair. The NHS phrasing is that it is not visible unless the hair is very short, and a grade 2 is usually on the safe side of that line, but "usually" is doing work there: scar width depends on scalp laxity, on tension at closure, and on the individual, and it is a fair question to put to him directly, along with a look at healed donor photographs from his own strip patients at the length you wear. Recovery differs too. Expect tightness across the back for the first week or two and sutures or staples out at about 10 to 14 days, against the wider clipped area and hundreds of small crusts you remember from FUE. The comparison at greater length is in FUE versus FUT, and how the finite donor gets spent across a lifetime, which is the whole logic of his plan, is in the donor area and overharvesting.

For calibration on "old": FUE has been the majority technique in ISHRS practice surveys for some years, but strip has not disappeared, and surgeons who keep both in their hands use strip specifically for large second sessions, tight donors and patients who want to keep length at the back. Crown work eats grafts, and 1,800 for a crown in a Norwood 3 that is progressing is a sensible, conservative number rather than an ambitious one. What I cannot judge from a forum post is your laxity, your density under magnification, or how your first donor healed, and those three things are exactly what his recommendation rests on. He has examined you twice. I would ask him the width question, ask to see his healed strip donors, and then let the answer be about your scalp rather than about which decade a method belongs to.

norwood3ben said:

keeping FUE "in reserve" for later

This is the bit that would have sold me. My surgeon talked me DOWN from doing the crown in May for the same reason, donor budget, and the idea that strip now leaves untouched scalp for FUE later is the first explanation of it that's actually clicked. Also, as someone who has spent two years telling this forum to pick the surgeon not the method, you're now going to have to take your own advice, mate.

Fair hit. Update: went back with the two questions. Width: he showed me a folder of his own strip donors at 12 months, clipped short, and the straight answer was "a fine line you'd see at a grade 1 and mostly lose at a 2 or 3, wider in the two men who had tight scalps". He measured my laxity by pinching the back of my head about, which was undignified, and said mine was fine.

Booked for October. Strip, about 1,800 to the crown, stitches out at two weeks, and I'm keeping the grade 2 but promising myself I won't go lower. The thing I've taken from this thread is that "modern" was never the question. The question was what this particular donor can afford, and the man who examined it twice knows that better than YouTube.