Hair Restoration Discussion Forum - By and For Hair Loss Patients
Go Back   Forum By and for Hair Loss Patients > Surgical Hair Restoration > Follicular Unit Extraction (FUE)

Welcome! This forum has over 180,000 posts and 12,000 before and after photos going back several years. To research a topic or physician, click on "Search" and enter the name.

You are currently a guest with limited access. By joining our FREE community you can post on this forum, reply privately to other members and or create your own profile, blog and photo album. Registration is easy, private and free so Join Today!

If you have any problems with the registration or login process, please contact us. If you are new please visit our FAQ.

Follicular Unit Extraction (FUE) Discuss and share your photos, experiences and results related to the Follicular Unit Extraction (FUE) hair transplant procedure, including its advantages, disadvantages and who is an ideal candidate.

Reply
 
LinkBack Thread Tools Search this Thread Display Modes
  #681   Top  
Old 08-13-2015, 05:26 PM
chrisis's Avatar
Member
Veteran Real Hair Club Member
 
Join Date: Feb 2012
Posts: 39
Last Online: 02-16-2017 04:00 AM
Default

Quote:
Originally Posted by adonix View Post
A friend of mine had FUT. His scar is ~2mm at most, meaning fantastic by FUT standards. However he cuts his hair very short and when I first saw it (I did not know he had a HT, nor much about HTs at the time), it looked scary. I thought he had a brain surgery.
This is exactly why I had FUE. Today I had a guard #1 hair cut on the back and side and there's no scar to see. I did not see the sense in swapping my paranoia about hair at the front for paranoia about the back of my head. Even if transection rates were inferior to strip (which has been theorised but not proven), then I'd still accept a10-20% transection rate to not have a strip scar. I don't think I'd go as far as 50%, but I don't think a reputable FUE surgeon would be transecting every other graft and still producing good results.
__________________
Online Patient Advisor for Dr. Bijan Feriduni, Coalition Member

My opinions are my own and don't necessarily represent that of Dr. Feriduni's.

Disclaimer: I am not a medical professional and my opinions should not be taken as medical advice.

View my Hair Loss Website
Reply With Quote
  #682   Top  
Old 08-13-2015, 06:10 PM
1978matt's Avatar
Senior Member
Celestial Follicle Club Member
 
Join Date: Apr 2012
Posts: 2,116
Default

There's actually a 3rd video interview I missed where Dr Ron says he has not seen fibrosis causing an issue over 2 FUE megasessions, so I will grant you that one. But one disagreement out of a dozen is not exactly significant.

I'm just thankful he didn't mention 'expanding crowns'!

Quote:
Originally Posted by 1978matt View Post
I watched those videos and heard NOTHING that contradicted Dr Feller. To summarise into bullet points what Dr Ron said in the interview:
  • Some doctors are doing good FUE.
  • FUE had similar early problems to when FUT first introduced.
  • FUE grafts are weaker.
  • Doctors [at the FUE Mediterranean Conference] where there showing techniques they use to 'try' to get similar growth to FUT.
  • Disagreed with Dr Lindsey suggestion that on average, FUE results '40% less full' than FUT. Felt it was nearer 20%.
  • FUE grafts are more fragile than FUT grafts.
  • A lot of steps needed to get 80-90% FUE graft survival.
  • FUE grafts weak.
  • Good FUE can have a very close growth rate (compared to strip) at least 80% of the time.
  • Increased risk of lesser growth with FUE.
  • FUT still 'has the edge' over FUE.
  • Isn't sure yet exactly how many grafts you can get using FUE exclusively.
  • Believes doing FUT first then FUE gets more overall grafts.
  • Lorenzo/Koray showing consistent results in 5-6,000 range.
  • Doesn't yet know how consistent the 8,9,10,000 graft cases can be.
  • Said that there are not enough cases in this range yet to know how consistent they are.
__________________
4,312 FUT grafts with Ray Konior, MD - August 2013
Regimen:
1. Propecia 1mg per week
2. Boots Ketoconazole Shampoo once per week
3. T-Gel Shampoo once per week
4. T-Sal Shampoo once per week

My HT results thread and video
Reply With Quote
  #683   Top  
Old 08-13-2015, 08:15 PM
fortune11's Avatar
Senior Member
Guru Real Hair Club Member
 
Join Date: May 2011
Posts: 221
Last Online: 06-16-2017 06:43 PM
Default

Quote:
Originally Posted by Dr. Tejinder Bhatti View Post
My basic training is as a plastic & reconstructive surgeon and I wandered all over the United States from 1997-2001 trying to learn the pearls of cosmetic plastic surgery for which I visited Drs Sherrel J Aston and Daniel Baker in their Manhattan hospital, Dr Ian Jackson of Detroit to learn how to manipulate the skull, Dr Bhangoo in Buffalo to learn all the tucks I needed to learn and last but not the least I spent time with DrsTessler and Aronovitz in Southfiled, Michigan to learn the tricks of FUT hair transplant surgery.
I never knew all the principles of nips and tucks that I would learn would come to naught and have no meaning and set me thinking after your sweeping statement that skin does not stretch, Dr Feller.
Well, how does facelift, necklift, tummy tuck, body lift, and even scalp reduction work then?
Well if crowns won't stretch , can you please throw some wisdom on why they do not in light of above accepted principles of plastic surgery!
I was among those urging Dr Feller to address the "expanding crown " issue raised by Dr Bhatti and I found Dr Feller's explanation satisfactory.

When I posted on this forum in 2004 after my first HT (FUT), one of the highlights of my story that I was excited about was the apparent "facelift " that my forehead got and all the lines just disappeared . But alas , over the next few months my scalp adjusted and the wrinkles etc came back. So it was more the "rubber band " effect , only in slow motion. Same problem also exists with a lot of these nip and tuck surgeries , where immediate results look good but then over time skin sags / expands again.

That being said, I do think that scalp laxity is somewhat of a meaningful factor in terms of FUT effectiveness -- especially given Dr Fellers assertion (and one I agree with) that FUT is more suited for megasessions. Megasessions also require taking bigger strips.


On a side note, I wasn't aware of any "accepted principles " of plastic surgery . I live in an area in Southern California where every fourth person has had some cosmetic surgery type work done on themselves (non HT) and the results vary a hell of a lot , especially on aging bodies . Actually all considering , we HT patients (especially FUT ones) have a more remarkable consistency of results , relatively speaking, than some of these other procedures. Atleast from seeing the results posted on this forum.
__________________
---------------------------------------------------------------------------------------
FUT #1, ~ 1600 grafts hairline (Ron Shapiro 2004)
FUT #2 ~ 2000 grafts frontal third (Ziering 2011)
FUT #3 ~ 1900 grafts midscalp (Ron Shapiro early 2015)
FUE ~ 1500 grafts frontal third, side scalp, FUT scar repair --300 beard, 1200 scalp (Ron Shapiro, late 2016)

http://www.hairrestorationnetwork.co...t-patient.html
---------------------------------------------------------------------------------------
Reply With Quote
  #684   Top  
Old 08-13-2015, 11:50 PM
mav23100gunther's Avatar
Senior Member
Follicular Salvation Club Member
 
Join Date: Apr 2015
Posts: 1,076
Last Online: 07-17-2017 10:29 PM
Default

Quote:
Originally Posted by Dr. Alan Feller View Post
Mav, I already answered this question, but I'll do so again.

The issue of so-called "crown stretching" is a non-existent phenomenon. It was a distraction invented by Dr. Bhatti to find something, anything, to throw at FUT to discredit it on this thread. Have you ever seen any posts online of patients discussing this or even complaining about it? None.

I've never had a patient of mine nor anybody else's come to my office and complain of "crown stretch". And the reasons are obvious.

Let's say Dr. Bhatti's numbers are correct (although I have no idea where he got them from). Then you are looking at about a 5mm "stretch" in the skin from the donor scar all the way up to the crown. This 5mm will be distributed throughout the scalp and not result in 5 mm of displacement several inches away.

Dr. Bhatti's diagram was incorrect and disingenuous because he treated the donor in his diagram like a bed sheet. A one inch pull on one end results in a one inch pull on the other end. The difference is, the skin is attached to the skull all along its length and it stretches so pulling on one end does not easily translate to the other end. Think of a rubber band bonded to the surface of a table at several points. Then pull on one end. See how well it translates to the other. Not well, thankfully.

Another disingenuous thing about his diagram is that in the "after" diagram there is no hair on the patient. The whole idea of the surgery was to put hair on the top of the head and it is in absence in his after diagram.

So let's say the guy is a stage 7 as depicted in the diagram. Do you think it matters if he has an extra 5mm of crown from stretch (if that's really happening) if the front half of his head went from cue ball to puffy hair? Of course not.

Again, Dr. Bhatti just put this out there to present some sort of equivalence in detriment between FUT and FUE and avoid answering my questions. Did he really stop performing FUT due to this heretofore unheard of complaint or phenomenon? Was the dreaded "crown stretch" something he discussed with his patients during his past life as an eeeevil FUT surgeon and included in his informed consent? I highly doubt it. Or did he just invent it for the purposes of this thread? He was trying to find an equivalent negative in FUT to compare with the very real detriments of FUE that I have been discussing in great detail and without any substantive opposition on his part.

And he failed because the three detrimental forces of FUE are real and I have been describing and discussing them for 14 years. They also explain the very real complaints by very real patients online as to why most FUE results are inferior to their equivalent FUT counterparts. The only stretching going on here is with the truth.
Thanks Dr Feller, very informative!
Reply With Quote
  #685   Top  
Old 08-14-2015, 08:12 AM
Swooping's Avatar
Senior Member
Guru Real Hair Club Member
 
Join Date: Dec 2014
Posts: 334
Last Online: Today 06:40 AM
Default

Quote:
Originally Posted by Mick50 View Post
Getting back to the original title of this thread 'FUT is more popular than FUE' if anyone cares to checkout the threads posted by patients on this website say for the last 5 years I think the FUE cases come out on top although most of them are in Europe and Asia it must be said ,
maybe the title of this thread should read 'FUT is more popular than FUE in the USA'
Census results of ISHRS 2015 results say it's 50/50 now. However the trending growth of FUE is extremely high and will continue his march. This will only continue to do so until FUT becomes a small niche pick. It's inevitable. One could pretty much say that worldwide FUE is already more popular, no doubt.

Perhaps FUT does have a slight edge when we look at the outcome. However the reality is that people don't care about this slight edge. What consumers want is FUE. And the market will drive towards that. In fact it's already doing that in full speed.

I think this is a excellent development. FUT will go slowly to the graveyard while the focus is set on FUE worldwide. This can only stimulate new innovation/progress. That's what we all want.
__________________
Proud to be a representative of world elite hair transplant surgeon Dr. Bisanga - BHR Clinic.
Hairtransplantelite.com
YouTube
Online consultations: damian@bhrclinic.com
Reply With Quote
  #686   Top  
Old 08-14-2015, 09:10 AM
Mick50's Avatar
Senior Member
Mentor Real Hair Club Member
 
Join Date: Feb 2013
Posts: 552
Last Online: 07-15-2017 06:48 AM
Default

As much as I respect Dr feller and his opinions great to have someone with his experience posting on this website and he's right, FUE clinics have a duty to give the whole story regarding FUE scarring,potential damage to grafts etc but I still have to agree with you I actually think FUE is in it's infancy, I know it's been around for 15 years or so but it's only in the last 5 years that it's permeating the general public's awareness be it through celebrities like Wayne Rooney having an FUE as well as plenty of online results from the likes of Dr Lorenzo Erdogan etc.

Although I believe FUE is on the rise i think everyone who has contributed to this thread should thank Dr Feller whether they agree with him or not as he is the only Dr I have read who points out the drawbacks with FUE and we as patients deserve to know the whole picture. I'm actually basing my views on this subject more to do with my views of human nature I just think guys will opt for FUE to avoid the scar even though the yield will be lower irrational I know given that most scars are pretty much undetectable most of the time done by the Likes of Dr Feller and Dr Lindsey but just the chance of it going wrong will put a lot of guys off

Last edited by Mick50; 08-14-2015 at 09:33 AM.
Reply With Quote
  #687   Top  
Old 08-14-2015, 09:54 AM
Dr. Tejinder Bhatti's Avatar
Senior Member
Guru Real Hair Club Member
 
Join Date: May 2010
Posts: 217
Last Online: 06-09-2017 10:28 PM
Default VIDEO: My technique of harvesting in an FUE megasession- scalp, beard and chest.

Quote:
Originally Posted by Bill - Managing Publisher View Post
Dr. Feller,

I realize that this post is several pages back but I just wanted to chime in here. While your statement may be true, I do not believe that Dr. Bhatti is quitting in the middle of any debate. This "debate" is ongoing and in actuality has no end. I truly appreciate and respect Dr. Bhatti for coming on here and sharing his point of view, which in essence is contributing to an ongoing debate, not quitting before the end - since it never ends.

To Everyone,

I commend both Dr. Feller and Dr. Bhatti for sharing two different points of view. Ultimately, both of them are sharing your input based on their own experience. Personally, I believe the three forces constantly discussed here do exist but I also believe that some surgeons have been able to either get around or overcome them. In other words, I don't think these forces are always as detrimental as Dr. Feller makes them out to be.

At the end of the day, it's one physician's experience against another's. Assuming both are being honest, one could suggest that Dr. Bhatti has found a way to overcome these negative forces while Dr. Feller has not. On the other hand, if Dr. Bhatti has found a way to overcome these forces (assuming they are being understood correctly), he should do his best to demonstrate this to his physician colleagues, perhaps at the annual ISHRS meetings. He should also do his best to make his case in the court of public opinion (namely patients) to demonstrate this online. I would suggest educational videos that showcase an actual procedure with a detailed description of the extraction process that also shows each graft after harvesting and how it's placed into recipient sites (which also ultimately impacts growth yield).

At the end of the day, I think this perpetual online debate is healthy and provides patients with a lot of information. Does it end the debate? No. Will Dr. Feller or Dr. Bhatti folding and agreeing with the other (which I don't believe will ever happen) end the debate? No, because other physicians continue to see things differently.

Frankly, unless there is a scientific approach to FUE and a universal understanding of the procedure and how to overcome its hurdles, I believe the debate will continue for years to come. In the meantime, I thank you for everyone's contribution and look forward to reading additional input, hopefully that includes other physicians' opinions as well.

Best wishes,

Bill


Bill,

In continuation of Dr Feller's informative thread on the benefits of FUE vis-a-vis FUT in modern day practice of surgical hair restoration, I post herewith a video taken yesterday after you asked me to do so.

The video was shot impromptu in a case with extensive balding and we could harvest 2406 scalp grafts, 1312 beard grafts and 1177 chest grafts.

Such megasessions were unheard of till the advent of modern day FUE.

If you see the video closely, the forces of compression and torsion have clearly been overcome. The force of traction does exist but it does not adversely affect my yield and therefore it does not worry me.

The fourth force of transection has been reduced to almost 1-5 %. Partial transections can go higher.

Due to better honed skills,a few tricks in the FUE bag and a larger number of clients available to do FUE on, today the results of FUE compare very favorably to those of FUT. This was missing in yester years when FUE was done for small indications alone; and this continues to be the case with centers which do under 700 per occasional patient.

Lack of experience will never hone surgical skills.

I would like to add that I do all extractions myself. I have never employed another other doctor/ technician to do my harvesting for me and I never will. This is the most essential part of the whole procedure and only if the doctor harvests the grafts himself can he ensure quality and consistency of results in his practice.

In my opinion, any doctor who has the requisite eagerness to learn and the right amount of patience for the arduous procedure can acquire reasonable skills in FUE harvesting after having done one case each day for 6 months following adequate mentorship.

I would humbly submit that I have done over 7.65 million graft extractions (viable grafts only) MYSELF during my practice. However, Dr Feller calls me a newbie!
(@ Dr Feller: But, Sir, since you have been in the hair transplant industry for longer, I have no reservation in granting to you this liberty.)

Best wishes to forum members and I hope to hear your comments about my technique.
N.B.- The person being counseled in the video is not on whom the procedure was done. The procedure was on a healthy type 5 pattern Indian male. He did not give permission to be revealed.

Last edited by Dr. Tejinder Bhatti; 08-22-2015 at 10:55 AM. Reason: Titles added to each section of harvesting procedure for better explanation of technique. Content remains unchanged.
Reply With Quote
  #688   Top  
Old 08-14-2015, 10:13 AM
NickBaron's Avatar
Junior Member
Veteran Real Hair Club Member
 
Join Date: Dec 2014
Posts: 21
Last Online: 09-03-2015 08:55 AM
Default

My name is Nick and I work for Dr De Reys who is an FUE-only specialist.

Firstly, my thanks and respect to Dr Feller whose medical opinion is of great value to many of the readers here.

Dr De Reys has specialised in FUE since its inception and chooses not to perform FUT.

We expect a very high growth rate mainly because the doctor has developed an extremely precise manual technique after transplanting millions of hair grafts over the years.

Using a manual punch, the doctor is able to 'feel' the root of each hair during extraction and avoids transecting the grafts.

Transection (accidentally splitting the root of the hair graft) can be a major issue for FUE with inexperienced staff or with automatic drills as Dr Feller says.

We preserve the grafts after extraction with the industry-leading nutrient solution Hyperthermosol so graft survival is not an issue with modern FUE as practiced by Dr De Reys.

The main reason why Dr De Reys does not perform FUT is that he is often called on to repair FUT scars.

This can be done in a number of ways:

1. A trichophytic closure can used to attempt to 'seal' the scar although such seals often reopen, especially after physical activity.

2. The other way is to fill up an FUT scar with FUE grafts in order to conceal the scar.

Dr De Reys always prefers to maximise the number of grafts in any operation and he sees scar repair as a waste of valuable grafts.

These grafts could be used to build density or create a stronger hairline so, in his view, this is a waste of grafts.

The number of grafts available is limited so wasting even a single graft is a loss.

Dr Feller rightly mentions the risks of badly-performed FUE however he also points out that,

"FUE is the "have your cake and eat it to" procedure. And in some cases this may be the case. Such as in the hands of very dedicated and very experienced physician practitioners who carefully screen their patients."

This describes Dr De Reys' work and this is what we do.

We are careful with patient expectations however after transplanting using only the FUE method for many years on a range of patients, right up to Norwood 5/6, our experience is that patients are extremely happy with the strong growth they get from Dr De Reys' technique.

They are doubly pleased that they do not have a large horizontal scar across the back of their head.

Wearing your hair short is something that you can do comfortably with FUE.

It gives patients the freedom to choose how they wear their hair.

From our view, these are some of the main reasons why patients choose our clinic.

There are a few of our FUE-only patient cases on this forum which can be found by searching for Dr De Reys which I would encourage you to do.


Last edited by David - Moderator; 08-14-2015 at 10:48 AM.
Reply With Quote
  #689   Top  
Old 08-14-2015, 11:11 AM
FUE2014's Avatar
Senior Member
Honorary Real Hair Club Member
 
Join Date: Dec 2013
Posts: 786
Last Online: 12-19-2015 03:34 PM
Default

Hi Bill,

Hope you don't mind me posting this link.

(Sorry, but we do not allow links back to this website because they do not allow links back to ours)

I think it's important because it somewhat contradicts what Dr Feller is saying now about FUE.

Last edited by David - Moderator; 08-14-2015 at 12:59 PM.
Reply With Quote
  #690   Top  
Old 08-14-2015, 11:53 AM
Dr. Alan Feller's Avatar
Senior Member
Celestial Follicle Club Member
 
Join Date: Oct 2002
Location: Great Neck, NY
Posts: 2,082
Last Online: 06-22-2017 12:19 PM
Default

Quote:
Originally Posted by NickBaron View Post
My name is Nick and I work for Dr De Reys who is an FUE-only specialist.

Firstly, my thanks and respect to Dr Feller whose medical opinion is of great value to many of the readers here.

Dr De Reys has specialised in FUE since its inception and chooses not to perform FUT.

We expect a very high growth rate mainly because the doctor has developed an extremely precise manual technique after transplanting millions of hair grafts over the years.

Using a manual punch, the doctor is able to 'feel' the root of each hair during extraction and avoids transecting the grafts.

Transection (accidentally splitting the root of the hair graft) can be a major issue for FUE with inexperienced staff or with automatic drills as Dr Feller says.

We preserve the grafts after extraction with the industry-leading nutrient solution Hyperthermosol so graft survival is not an issue with modern FUE as practiced by Dr De Reys.

The main reason why Dr De Reys does not perform FUT is that he is often called on to repair FUT scars.

This can be done in a number of ways:

1. A trichophytic closure can used to attempt to 'seal' the scar although such seals often reopen, especially after physical activity.

2. The other way is to fill up an FUT scar with FUE grafts in order to conceal the scar.

Dr De Reys always prefers to maximise the number of grafts in any operation and he sees scar repair as a waste of valuable grafts.

These grafts could be used to build density or create a stronger hairline so, in his view, this is a waste of grafts.

The number of grafts available is limited so wasting even a single graft is a loss.

Dr Feller rightly mentions the risks of badly-performed FUE however he also points out that,

"FUE is the "have your cake and eat it to" procedure. And in some cases this may be the case. Such as in the hands of very dedicated and very experienced physician practitioners who carefully screen their patients."

This describes Dr De Reys' work and this is what we do.

We are careful with patient expectations however after transplanting using only the FUE method for many years on a range of patients, right up to Norwood 5/6, our experience is that patients are extremely happy with the strong growth they get from Dr De Reys' technique.

They are doubly pleased that they do not have a large horizontal scar across the back of their head.

Wearing your hair short is something that you can do comfortably with FUE.

It gives patients the freedom to choose how they wear their hair.

From our view, these are some of the main reasons why patients choose our clinic.

There are a few of our FUE-only patient cases on this forum which can be found by searching for Dr De Reys which I would encourage you to do.
Thank you for the kind words, Nick.
I agree with Dr. De Reys' use of manual punches. I actually developed a motorized tool but abandoned it due to the loss of "feedback", or as you put it: "feel".
My best to you and your doctor.

Dr. Alan Feller
Great Neck, NY
__________________
Feller Medical, PC
Great Neck, NY

Dr. Alan Feller is a member of the Coalition of Independent Hair Restoration Physicians

Providing FUT, FUE, and mFUE
Reply With Quote
Reply

Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are On



All times are GMT -5. The time now is 11:59 AM.