Dr Tejinder Bhatti

Dear respected members, The issue of technicians vs. doctors for the surgical aspects of a hair transplant is a subject of growing debate in various arenas. The forums seem to have a mix of opinions as shown in this very thread. The ISHRS has also taken up this matter with heated and emotional disagreements among the membership. My position on the matter is that a doctor should be the one to perform the surgical portion of the procedure. Someone mentioned earlier in this thread that there are three parts to the surgery (in FUE); extraction, incisions and placement. This is incorrect as there are in fact four phases; Scoring, extraction, incisions then placement. The scoring and extraction, combined, are the most important aspects of the surgery as this determines the success or failure of the rest of the procedure. Next are the incisions as the incisions determine the angle and direction of the hairs once they are growing and they can also influence the survival of the grafts as a pattern of incisions that are too deep can cause excessive trauma to the scalp, which in turn can lead to necrosis of the recipient area. This would be a disaster for all involved and it is the doctor's job to do this correctly. Doctors should not be in the business of performing as many surgeries as possible and in my opinion, this is what the use of technicians as surgeons allows. It is commoditizing the industry and allowing doctors to have multiple teams of low paid technicians to maximize profits. When one goes in for a cardiac consultation they meet with a cardiac surgeon. Does the surgeon merely draw a "x" on the patient's chest during surgery and allow technicians to carry out the procedure? Of course not. A doctor should not ask a technician to do something he or she cannot do, or is not willing to do, themselves but this model is growing as the profit margins are too much to resist. There is also the issue of looking at a clinic's track record. It was presented as being a valid reference for consistency and quality. I disagree because if the clinic is indeed a technician clinic then it stands to reason that there are multiple technicians and without direct credit given to each technician one is unaware of whom exactly is responsible for which result that is presented. What happens if the best technician(s) leave the clinic? Is there a name change on the website? Is there any notification at all or does the clinic continue on as usual with zero indications that the "talent" has left? The doctor's name is the only thing that is visible. If you know that the doctor is the one doing the surgery then THAT is where you can say that the consistency is true as there is only one person to be truly held accountable for each and every result and that is the one person that has worked on each and every case actually performing surgery.

Hello Mr. harryforreal, Thank you for your suggestion on how to improve the knowledge of the viewing public with regards to our patient satisfaction. I know your heart was in the right place with your suggestion. The challenge with implementing something as you suggested is that it is difficult to get patients to share their result to begin with so asking them to act as a more blatant billboard for my services is not something I wish to do. I feel incredibly blessed when they agree to photos being taken to document the result and to be shared on the internet. For you to even see these photos in the first place means that the patient is very happy with the result. That is the whole point of sharing results photos (and videos) in the first place. I believe this to be the case with any clinic that shares photos to document results as it would be illogical for patients to agree to being displayed on the internet if they were not happy with their result. Ultimately, if the patient is willing to write their own review, then that is the ultimate yardstick of determining one's level of satisfaction. Unfortunately this is not something we can insist upon but it is however something we feel greatly honoured to receive.

Mr. bbtrojans, It was my pleasure. I'm happy to answer any further questions you may have.

Hello Mr. bbtrojans, I am always happy to hear when patients are considering me for their hair restoration needs but I am never disappointed when one of these patients chooses another doctor. That is the way of life as no single doctor is the favourite for every patient just like no single cricket team is the favourite for every fan. I greatly enjoy creating new hairlines as they are what define how we appear to others. It is a part of the first few nanoseconds of interaction we have with every person we meet and I feel it is imperative to get it right. Even the subconscious mind should not be able to see that the hairline is unnatural. This is why hairline design is a constant contradiction of itself. When I design a hairline there are two factors that matter, and only two. 1. Does it look natural today? 2. Will it look natural tomorrow? To balance these two questions is something that must be carefully considered. Many doctors will choose one, often at the expense of the other. For instance, if a doctor decides that the hairline must look natural today, especially according to the patient's wishes, then this approach may jepardize the tomorrow in this issue. This can many times require a high number of grafts as aggressively shaped hairlines must have higher density and this means less hair is available for the future. If a doctor chooses to address the future more so than today then less grafts will be used and more grafts will be available for the future but this can leave the patient wanting more work to "straighten" the hairline. Thus the same challenges are revealed again. When I create a new hairline I want to balance the needs of the patient with the desires of the patient and when you see a "straight" hairline it is because this design worked for the patient. I could easily create aggressive hairlines for all of my patients but then I would run the risk of using a cookie cutter approach. Regarding my team of advocates online, no such "team" exists as California states. I do have a lot of patients that share their personal experiences but they are not employed by me or anyone in my organization nor are they compensated for their efforts. If you have only considered me through observations I do encourage you to contact my office and submit your photos and information for a proper consultation. My recommendation will help you to decide if I am indeed right for you or if I am not and all of your questions can be put to rest. If you have already done so I thank you for your initial interest.

Hello Mr. Mikey1970, Permanent shock loss is an unfortunate side effect of surgery that may not have been performed correctly. However, this is not the common denominator for permanent shock loss in the recipient area as there may have been some hairs miniaturized, to a small or great degree, that were traumatized by the procedure and reacted severely enough that they did not return. If you are seeing improvements lately then perhaps it has to do with your medication. Did you start taking medication in the past year or so? I assume you are referencing finasteride when you say medication and if I am correct in this assumption then I think it is wise to allow the medication more time to help. The improvements can be seen for up to two full years before the benefits plateau. If you started medication more than two years ago then it has likely reached it's peak contribution and is in a maintanence capacity at this point. Shock in general does not take a year or more to return but it doesn't mean this isn't happening to you. There are multiple possibilities that have affected your outcome but in the end it could simply be due to damage caused by your small procedure. It is not unheard of and is in fact more common than most realize.

Mr. Bhushan88, If you wish to keep your existing hair then you must continue to take medication after the hair transplant. The surgery only fills the regions where hair fall has taken place. If you do not take medication after the hair transplant the hair that is transplanted should grow fine (depending on the clinic you have chosen) but the native hair will continue to fall. This is a fact that is indisputable.

Hello Mr. Seemer, Forgive me if you have stated so but I do not see anywhere that you are taking proven medications to stop your hair loss. Given that there are no photos that are posted I can only say that before you proceed with any surgery you should see if you can recover some of your hair through medical means, such as Regaine or Propecia. These can be effective for not just stopping your loss, which is the biggest long term benefit, but they can also reverse your loss to at least a minor degree, major in some cases. If someone offers you anything else you can research it online to see if it is indeed what you are being told but currently only the two I have mentioned are FDA approved for hair loss. Once you learn about these medications and you have spent several months on them then you will be in a much stronger position to move forward with a surgery. Without one or both of these medications, having a hair transplant will be no different than building a house without a strong foundation. What has been constructed will eventually be in need of being rebuilt again.

Good day to everyone. Today I present for your observation and discussion a case that has come into my clinic. FUE and SMP is a lovely combination. It allows a person to hide the minuscule, already difficult to see scars, and they are almost completely invisible even on a close crop. This not a necessary adjunct to FUE but it is a valuable one for those that wish to have the ultimate degree of cosmetic donor perfection. This 40 years old Tunisian French man received 2800 scalp grafts for the front half of his scalp in June 2014. He then had SMP as a holdover procedure until he could return for more FUE work with me. He has now come for coverage of the midscalp. These photos are taken right before his second procedure with me and right after the entire scalp was shaved. The effect is obvious.

Hello Mr. MJHT, Have you submitted your information for my review and assessment? I am honoured to be listed as one of the doctors you are considering for your hair restoration needs. I would like to point out that the information and care you will receive after your surgery is just as extensive as what you will receive before surgery. I insist on communication and openness. I must ask, if you do not believe my hairlines are very natural why are you considering me? I prefer age appropriate designs and not being so aggressive that the donor supply is prematurely depleted. I am quite proud of my hairlines and my patients tend to believe my hairlines are of very high quality as well. This is all subjective of course and no single result is universally reviewed as perfect by all critics but if you have me in such a high position of consideration, down to the final three, why am I listed at all if you do not believe my hairlines are natural? Regardless, you have my word that if I am chosen as your final choice I will gladly and eagerly work with you to determine what exactly natural means to you and I will endeavour to meet your goals using all techniques and tools at my disposal. If you have any questions feel free to ask at any time.

Mr. Pkipling, This is a very good subject but one that is very difficult to answer easily. I believe that, as medical professionals, we have a responsibility to do no harm (which is one reason I ceased performing FUSS). One of the ways we can "do no harm" is to deny cosmetic surgery to those that may not be able to handle the emotional toll it can inflict because in the long term the procedure may cause more problems than it solves by putting the patient into a state of despair that is not easily resolved. FUSS can create this issue by the mere presence of the donor scar regardless of how excellent the result is. Bad growth only compounds the issue and in the case of FUE, even without the linear scar, bad growth can decimate one's emotional and psychological well being. Patients get a hair transplant to look better and when they believe this is not going to be the end result, or worse, they believe they are having a negative result, everyone loses. During consultations we have to use our very limited amount of time with the patient to spot any issue that may indicate something is amiss. In my clinic, however, I choose to use this time to get to know the patient as well as I can for the general well being of the patient and the success of their procedure. By establishing a positive rapport we can influence the overall tone of the post-operative process. This is one reason why I do all of my own consultations as well as pre-operative and post-operative interactions. I try to have a relationship with the patient and with thorough education before, during and after the procedure we can greatly reduce the incidence of despair even in those that may have originally had misconceptions about the timeline for growth. These issues arise when patients are left alone after surgery and have no one to reach out to so they rely on photos of other patients to judge their own success, for better or for worse. I feel this is wrong and is why we see some patients panicking well before it is necessary to do so.

Mr. Future-HT, The issue of transection is easy to confuse, sometimes by design. Transection is by definition the cross cutting of a follicular unit in vivo. When you read studies about transection they usually are controlled in a manner that allows the top half to be transected or the bottom half will be transected, either very neatly. In surgery, when a follicle is transected, it is not in a controlled manner bisecting the top half from the bottom half. It is in a slightly parallel, diagonal direction where some or all of the follicle will be destroyed. If you are targeting a four hair follicular unit and transection occurs you will wind up with a follicular unit that will grow three hairs instead of four, or perhaps only one hair out of four. In inexperienced hands, especially those that shake and cannot control the process well, this will be a common occurrence along with very high rates of complete follicular destruction, thereby making the procedure a waste of time, money and of course valuable donor hair. The challenge is to avoid these transections altogether and only very experienced hands can do this on a consistent basis. This is the key to doing proper research. You should find a clinic where high quality results are plentiful and you need not search endlessly to find the next result hidden in some remote corner of the internet or only available upon request.

Thank you for everyone's input and thank you to Raj_Jayukdht for updating us all on his progress. By sharing, we are educating. We have two obvious issues in front of us with regards to the case of Raj_Jayukdht. 1. There is an obvious and significant cosmetic improvement that drastically improves the overall aesthetic. For this I am very happy and am glad that Raj_Jayukdht see this as a benefit as well. 2. The two areas of poor growth in the bilateral temporal regions is unusual. Both areas are fairly devoid of any hair at all and in very isolated but well defined outlines. To have such a clear delineation between growth and no growth indicates an unknown trauma, either external or internal. Raj_Jayukdht, I would like to speak with you regarding your case as soon as possible so please contact me at your earliest convenience so we can arrange a meeting. I intend to do two things; the first is to investigate as much as possible what the cause is for this issue and the second is to do whatever I can within my power to correct it. This I promise.

I fully believe in the patient/doctor relationship. In India it is very difficult to find hair restoration clinics that have much direct involvement by the doctor in even the execution of graft extraction, much less the consultations. Without a solid patient/doctor relationship established from the initial counceling it can be difficult to establish a proper degree of trust. It is not just the patient that must develop a trust for the doctor, the doctor must develop a trust in the patient; is the patient reasonable in his expectations? Is the patient aware of all aspects of the procedure? Are all of the patient's questions answered? I do not wish for patients to come in to the procedure with questions that should have been addressed during a counseling session which is why I prefer to do them myself.

I have. Greetings to everyone involved in this thread. I have read it in it's entirety with great interest but it appears the topic has veered from the original issue presented by Mr. FUE2014. I believe there is indeed a body of poor results but it has to do more with the incredible influx of clinics that are now offering FUE with a very low, seemingly non-existent, surgical standard. If clinics have a high standard for surigical performance, enough years of experience and do not allow unlicenced technicians to perform the procedure then FUE is a wonderful modern alternative to FUSS with a strong expected outcome. In my experience in India, the market is very similar to that of Turkey, where hundreds of clinics open with little to no experience and potentially without a doctor in sight. It is an epidemic really, and hits at the core problem with FUE. It is too easy for lay persons or inexperienced medical personnel to get involved and bring down the average success rate. A similar issue is occuring in the United States to a lesser degree. Automated machines are being marketed to clinics as an adjunct to their existing practices where they perform other medical cosmetic procedures. This too brings down the overall quality of results. There is no passion, there is no dediction, there is no specialization. In India, I am an anomaly in that I am one of the small handful (and that is being generous) of doctors that performs FUE myself and because I do the procedure myself I am able to control every aspect of the procedure. Having performed many FUSS procedures over the years I am happy that I have switched to FUE only and I can say without hesitation that FUE is much more labor intenstive. I do not know of any of my colleagues that have also performed both to a respectable degree that will disagree with me, present company excluded of course. FUSS does have it's own set of skills and requirements, of course with great skill, but it is not as intensive as FUE. To compare, a proper strip is removed with a scalpel that incises the flesh to separate it from the donor scalp. Suturing is the standard for closure but staples are used by some to speed the process further. Some strips will take 20 minutes to remove but if safely and properly performed the strip removal process takes 45 minutes to an hour. Once completed the doctor can take a break or move on to the second, third or fourth patient while the technicians dissect the tissue to get to the follicular units. FUE extraction however cannot be peformed in 45 minutes even in small cases. I get no such break after such a short amount of work. FUE extraction takes hours and the process is repetitive and requires extreme concentration, not to mention eye-hand coordination, over the course of several hours. This is not seen in strip excision. If performed properly and at an appropriate clinic there is much more direct involvement between doctor and patient with FUE than compared to strip thus there is more intensive work for the doctor overall. FUE can never be supplanted by FUSS. The genie, as they say, is out of the bottle but it is imperative for patients to perform their diligence properly and to do their best not to be distracted by marketing and interaction that deflects from the points you wish to investigate. Does your clinic have consistent results or when you push for answers about results do you keep getting excuses? Mr. FUE2014, I hope I have answered your question and shed some light on the issue with another point of view.

Dear Mr. Shadow of the Empire State, I honestly do appreciate your concern for the younger patient and that you have concern regarding the many nuances that one must understand before accepting the option of surgical hair restoration. When we make our assessments for the surgical option we absolutely take the future into account. As I type this I realize it is a bit cliche and is repeated almost as a standard response for many but it is true, at least for me. The easy way to address your concerns is twofold. 1. The patient will not have a strip scar from the procedure, much less any sort of modified scars. 2. I do not plan on aggressively closing the temples or lowering the hairline on the young man as I wish for my work to stand the test of time. 1500 grafts is not a lot of hair and is minor compared to some of the cases presented by doctors that like to "dense pack" three and four thousand grafts into a small few centimetres of the frontal hairline. Cases like that are taking up to 50% of the patient's donor just for hairline work! I wish for my patients to have a natural appearance now and as they continue to age. The chance of someone progressing to a NW6, even while on medication, still exists so we musn't throw the kitchen sink at the front and leave nothing for the back. In the end, naturalness is relative. Some say that naturalness is density. Some say naturalness is nothing short of a full head of hair.To me, naturalness means that the hairs placed by a surgeon's hand are done so in a manner that mimics nature, both in angle and direction and the exit point is not "pluggy". Hair loss patterns occur in many styles not found on the traditional NW scale. I've seen many examples of grown men, some in their forties and fifties, maintaining their juvenile hairlines and strong frontal scalp density but developing large bald crowns, all without having ever had hair restoration surgery. I've also seen many men that have maintained much of their hair but developed channel recession down either side of the scalp including the disappearance of the lateral humps. These are patterns that many warn will occur only after hair transplantation has been performed and with continued loss however these patterns I have seen occur without any surgery whatsoever. So again, rhetorically, what is natural? Again, I do appreciate the concern and it is warranted at first glance but I do take this very seriously and want the best for this young man as well as every other patient I am priviledged enough to perform surgery on. You have my word I will take great care in the design and execution of his procedure.

Hello Mr. Harin, Thank you for your comment and your question. The beard can be a wonderful source of donor hair for those that have not enough scalp hair. It is the heartiest of donor hairs outside of the scalp region. The problem for many patients is that beard hair is more coarse than scalp hair and is often a different texture and sometimes even a different color. In cases such as the one above beard hair should not be used exclusively in the crown as it would not produce as natural a result as would a combination of beard/scalp or beard/chest hair, assuming the chest hair is of a finer caliber. I hope this answers your question to your satisfaction.

Thanks for the compliments, harryforreal. The distinguishing factors of traction alopecia commonly seen in the Sikh population are as under- 1. Alopecia occurs at a much earlier age- even 12 years. 2. Alopecia is ore on one side than on the other since when the bun is tied, one side gets maximum stretch like the ropes of a tent. 3. There is no thinning of adjacent hairs 4. There is a clear cut defined line 5. The aloecia if severe is also seen behind the ears which does not happen in genetic baldness. Merely tying a ponytail will not cause traction alopecia. It has to be tied real tight! A tight knot of the threads of a bandana make matters even worse. Please see pictures attached. A ponytail as in the picture if tied loose is safe. More videos can be seen at-

Thank you David, Sean, Lileli, Td06, Voxman and hairshopeing! Sikh pattern traction alopecia results due to a tightly tied top knot/ man bun and not diue to a turban as commonly interpreted. Since our clinic is located in the Indian Punjab, we get the largest number of Sikh pattern traction alopecia clients anywhere in the world. However I know Canadian doctors like Dr Rahal and Dr Wong and doctors in the California belt where the Sikh population is large also get a significant number of clients and have good experience treating this entity. David, I see that almost 80% Sikhs who have tied the top knot have varying degrees of Sikh pattern traction alopecia resulting in a broken hairline for which they seek hair transplant.

Mr. MavGunther23100, Thank you for your additional questions. "Dr Bhatti, What relevence is the BHT statement to your argument? Now that H&W also offer FUE , there are not many recommended FUSS only surgeons that I am aware of. Most surgeons can now offer FUT until stripped out, and then FUE no?" There are probably many FUSS only surgeons you are not aware of, as well is the case for me but of course I do not know with any certainty. I'm sure there are many hold outs of the procedure in North America but with time the exclusive nature of these clinics diminishes. Also understand that FUE is different from BHT and just because the tools are similar does not mean the procedure is the same. There are additional challenges that should not be attempted until scalp FUE confidence can be established. "See the link below where Dr Feller extended an offer to Blake. http://www.hairrestorationnetwork.co...-feller-2.html'>http://www.hairrestorationnetwork.co...-feller-2.html'>http://www.hairrestorationnetwork.co...-feller-2.html'>http://www.hairrestorationnetwork.co...-feller-2.html http://www.hairrestorationnetwork.co...-feller-2.html" Unfortunately an offer of training is only that, an offer and one that is buried in a thread unrelated to the subject. Let us move on now to questions about FUE if my involvement is to continue. However, I think it best to move on to new threads where I am happy to engage and share. I no longer wish to participate in this thread as I believe it has not only run it's course but it is counter-productive to the spirit of this forum. Good day.

Mr. KO, Thank your for your question. "If not, then why do you refer to FUT as the "Gold Standard"?" I must clarify, FUSS is the gold standard in the industry. FUE is the standard in my clinic.

Mr. Lileli sir, you ask a very good question that I am happy to answer for you. "Dr. Bhatti, Let's say a patient gets 4000 grafts implanted via fue. The second time they come back, let's say in a year, for another 4000 would it be very difficult because of the fibrosis build up?" Scar tissue can indeed create problems if we do not approach the situation with care, experience and understanding. The scars have matured mostly in 9 months time after which the skin is soft enough for a sharp punch to enter easily. In addition, when we use smaller punches common today the space between the extractions is equally just as small so there is greater room for variance between previous exractions thus reducing the peripheral impact of the resulting subdermal scarring. As you may know I use the Harris blunt punch. However for the second and subsequent sessions I use the sharp punch used in CIT. I have a simple way to calculate the number of grafts I will get from the patient in a lifetime through my technique of leaving one follicle (what I call the sentinel follicle') in between 2 punch holes (1:5 or 20% harvest). AssumeI get 4000 scalp grafts in the first session. The second shall give me half the amount- 2000 and similarly sessions that follow decrease the amount that is harvestable by 50% each session. If we say the back has 20,000 follicular units, we should not harvest ever beyond 40% or the skin starts to show. Much like the baldness in the scalp starts to appear when 50% hair are lost. There is no great limit of grafts from the scalp available through FUE compared to FUT. I do not think there is any marked difference in lifetime yield from the scalp as compared to FUSS. And remember we do not expand the crown And then we have the luxury of a whole lot of body hair that the FUT only surgeon cannot get to. Btw, I believe we should reference FUT as FUSS as FUT is technically both FUE and strip. FUSS specifically references strip alone.

Unusual that you would pick out this issue among the rest. Dr. Feller, you have my most sincere and whole hearted apology for saying that you have been making baseless rantings. I had no idea how this would be misinterpreted and cause you so much distress. "Respectfully, EVERYTHING written on these chat sites are informal opinion." Then we are done here. Nothing you have presented is a fact, just your "informal opinion" according to your own words spoken here. Everything I have expressed about your opinion is also an opinion based on my own experience. The facts are that you do not believe FUE is as successful for me and other FUE practioners claim despite the hundreds and hundreds of photos and HD videos that say the opposite. Another fact is that I believe you have motive to be the only reputable hair restoration physician in the world to make the claims that the three forces experienced by FUE grafts during harvest are detrimental to consistently successful outcomes and have not been overcome. Who is right and who is wrong? I believe we are both right. You have your FUE results, I have my own as do the dozens of recognized FUE physicians in the world. Until real studies can be performed everything else is pure conjecture and "informal opinion" based on our own respective experiences. Good day.

Mr. Pupdaddy, You are correct and I apologize. I should have followed up. What is an FUE megasession? I consider an FUE megasession to be a session that requires more than 3000 scalp grafts. Speed is an essential component for megasessions. FUE grafts have to have minimum out of body time for satisfactory survival. I never do a megasession stretching beyond 2 days for the following reasons- 1. The efficacy of lidocaine (local anesthetic) becomes lesser on the second day and on subsequent days due to the inflammatory process that kicks off when the body starts to heal. The alkaline environment that results makes the anesthetic less effective. 2. More resulting pain and discomfort, more bleeding during the procedure and increased popping and fatigue of implanting grafts. 3. Longer the procedure is drawn over more than a day and a half, more the swelling and more the fibrosis affecting the final yield of grafts that eventually grow. Speed is single most essential component of FUE technique esp. for megasessions. In my practice speed has served me well but I still rarely move past the 3000 graft per day threshold as we must be reasonable with the trauma we are creating to the scalp, the grafts, the patient and our physcial limitations. The out of body time is never more than 4-6 hours maximum for grafts in my clinic. This is the standard for my practice and FUE and was the standard for my FUT as well. I just do not like for grafts to be out of the body. Your suggestion about rotating between set numbers is interesting but there is a patient comfort component we must consider. Patients are usually more comfortable with minimal requirements for movement. We do take breaks of course but I will admit that your suggestion has me thinking. Thus is the power of positive exchange:) I hope this helps and accept my apology for not responding to you earlier. There is a book coming out this month that focuses solely on FUE. It is the first of it's kind that I am aware of and is exhaustive in it's value. I co-authored the chapter on "Avoiding Disatrous Outcomes in FUE Practice". If you send your address through PM I will send you a copy. See, Dr. Feller is not the only doctor that has been published regarding FUE:) Mr. Bill, I apologize if I misinterpreted the word permission as I was not indicating that you were condoning my actions, just that you were allowing the new link to the edit to be presented. It was not my intention. Mr. Mavgunther23100, " I thought it was well known that Dr Blake was performing his internship/residency with Dr Feller." If this is true I was not aware of it. It is my understanding that this was first revealed in April, 2015, two months before Dr. Blake's departure from his official duties as moderator. The two months since the announcement are fine as the conflict was revealed. If the arrangment was revealed before April of this year please share the link. If it is true, and the relationship was revealed from the beginning, two years ago, then I will retract my opinion and apologize to Dr. Feller and Dr. Blake for my oversight. If it is not true then my opinion stands. It is common practice and requirement to reveal conflicts of interest and knowingly and conciously influencing patients in such a manner is not required for a conflict to exist. There is a potential subcouncious influence that an arrangement can have on one's opinion, in this case moderation, so it is incumbent upon those in the conflict to reveal the arrangement so that patients that may be influenced by those involved can make informed decisions based on such relationships. Revealing of conflicts of interest is designed to protect patients. As a paying members of this forum physicians in competition also have a right to know. Dr. Feller, I will address you one final time. If you wish to have a debate about how this negativity started we can go all the way back to your accusation of my patient that he is a representative of my clinic. English is not my native language but even I know that when one refers to someone on the forums as a "representative" they are directly stating that the person is in the employ of a clinic. "He is a representative for a a physician practicing FUE." This is no other way to interpret your statements made on this subject. Do a search for the term representative on this forum and each reference will be made for actual representatives of clinics, not patients sharing their experiences. This is why I first posted on this thread, you were attacking my patient which I take personally. I was not involved prior. I called this thread baseless because it is your opinion only and you have no proof to support your position. Was my tone slightly harsh? For me, yes, but I find it difficult to believe you were genuinely offended. If you were then you have my apology but I feel it necessary that you should apologize to my patient. I require no such acknowledgement. Our respective videos show two things. I am fast as that has served me well as evidenced with multiple dozens of results and satisfied patients through the years. I have MANY documented results of my FUE patients which speaks to my success. If my technique is so "detrimental" I would not be in business today and one of the moderators of this forum would not be happy with me. It is public for all to see. I will no longer address your video as to do so only continues the negativity. I'm sure you have happy FUE patients and that is all that matters, yes? If you do not wish to answer the questions I posed, that is fine. I did not expect answers to begin with but I felt the need to ask. Time will reveal all. I will however ask some final questions of the readershi as they are more inclned to answer. 1. What determines the detriment of a surgical technique? The argument of it's technique without proof, pro or con, or the final result? 2. What determines the satsifaction of a patient? The result that he wished for or the manner in which he achieved the result? 3. What right is there by anyone to criticize a technique if the patient that wears the result of the technique is happy and satisfied enough to share with the world? If there are more questions about my FUE, I'm happy to discuss. If not then I will no longer take part in the negative direction of this thread. Good day.

I agree, the negativity has gone too far and I’m sure the posting history will show where the negativity is coming from. I will remind everyone that the video was not removed. The video remains on Youtube, untouched, and in five postings by Dr. Feller. Mr. Bill, you said the following, “I've already acknowledged that I haven't followed the debate closely over the last week or so. If discussion of the video is dead, that's fine. But I wanted to make it clear that I never advocated for the removal or editing of the original video. I am a firm believer that apart from minor revisions for spelling or grammar, members should stand behind their posts and do minimal editing." I did not suggest Mr. Bill that you advocate my actions. I stated earlier that you gave me permission. Do I misunderstand the word? I know the word “permission” to mean being allowed something. Does the word “permission” mean endorse or support? Indeed, you advised me and I chose to do what I thought would be acceptable. Dr. Feller has the original video posted five times so I did not believe it to be an issue and I do not understand why it is so controversial if the original is intact here and on my You Tube channel. I agree posts should remain with minor revisions for spelling or grammar and should not be removed but recent history suggests otherwise. My post was untouched but the video was edited over seventy pages ago and a private email exchange, that supports my original position still and shared without my permission, and I am being attacked for changing something that still exists in it’s original form with five copies and over 450 views. Dr. Feller even claimed that the embedding feature had been disabled when it clearly has not. Yet when another physician wishes to have his entire post removed it is done so without incident. Mr. Mav23100gunther, I believe this email trail, which was posted without my authorization, shows what I said from the beginning. I wished to concentrate on the extraction and I believe the circle of focus helps to do this. If you watch the edited version you will also see that from the 2:00 point to the 2:29 point there is no circle focus effect. You can also see that I have each sequence labeled for clarity and I have also included information about the forceps. They are the CIT forceps, which prevent crushing contrary to Dr. Feller’s claims. I’ve said this before. I am of the belief that this obsession with the video is another effort to detract from the lack of evidence to support Dr. Feller’s claims. He says the detriment nature of the three forces he lists are fact but the only fact is that they are his theory. He has no proof that these forces are so detrimental that they cannot be overcome, which is required in science and medicine before a challenge to refute can be made. I also believe this is a ruse to reduce the credibility of FUE in support of his new procedure which supposedly solves problems that none of you knew existed. I have some questions that I would like asked. 1. What is the size of the punch for mFUE? 2. How long has mFUE been in development? 3. Did Dr. Blake work on the development of mFUE while he was under your tutelage? 4. Did Dr. Blake know he would have a financial benefit from the development of mFUE or anything related to your practice? Mr. Mavgunther21300, I believe you asked earlier why mFUE was of any concern regarding this thread. I had elected to not continue with this line of thinking as I felt the thread was finally retiring but since it is now revived I will tell you why I was discussing this. I believe it was compulsory for the professional relationship between Dr. Feller and Dr. Blake to be revealed to the community from the beginning, which according to Dr. Blake was two years ago. Dr. Feller is a competitor, not necessarily to me, but to many doctors in North America and particularly in New York and many of them are paying members of this website. For there to be a moderator of a forum that influences the surgical decision of many many people with his “opinion” while simultaneously being influenced by a a paying member that is a competitor, with financial gain either directly or assumed from the relationship, is a conflict of interest. Harvard Medical School states… "Research that involves human study participants or samples is subjected to higher scrutiny with respect to the potential for financial conflicts of interest. This is because the ramifications of bias in clinical research are more immediate and directly impact the safety and welfare of clinical research participants. This rule guards against bias, or the appearance of bias, that might occur if a faculty member conducted clinical research in which she or he had a financial stake in the outcome or allegiance to the funding company. Such a conflict might cause the faculty member to alter his or her study design, conduct, or reporting of the research in some way, whether consciously or unconsciously, or it may cause the public to lose trust in the reliability of the research outcomes. " In a case such as Feller/Bloxham the “study participants” are you, the forum members. The “funding company” is Dr. Feller and the “faculty” is Dr. Blake. In some cases some financial associations are acceptable but in every case the relationship must be disclosed, much like how representative on the forums must disclose their relationship with the clinic they work for, which was what Dr. Feller was accusing my patient Sethicles of being. In short, Dr. Blake was working/training with Dr. Feller and developing a new technique for two years with the intent of profit once training was completed and a partnership was formed. It is my opinion, based on statements and timelines shared that this is the entire reason for Dr. Blakes admitted transition from believing in FUE to being a naysayer. It is also the reason for the re-emergence of Dr. Feller after a year and a half and these threads designed to discredit FUE and deliver mFUE as the solution to the problem that cannot be proven to exist outside of Dr. Feller’s hands. Good day.

Dear Dr. Feller, This is an interesting "olive branch" that is being extended. An olive branch with conditions attached is not olive branch, sir. It is a prickly thicket that serves your interests alone. You'll understand my hesitation. If you are referring to the "baseless" rant, comment there is no proof that you have presented. It is simply your opinion. You are assuming that the challenges you have experienced and have not ovecome in your FUE procedure are equally insurmountable by every other physician in the world. To apologize for this is to endorse your position, which I do not. In fact, the very idea of an apology for this, of all things, is humorous due to the sheer volume of insults and bulldog attacks you have made on not just me, which is of no real consequence, but my patients (Sethicles) and the respective readers and participants of this forum that dared to disagree with you. And I also see no need to admit any mistake with my video. You have zeroed in on my original post which is over sixty pages back, in the middle of this thread as it stands now, while you posted the original video in subsequent posts, five times no less which negated your "cover up" claims. The mistake was yours, sir; yours because you did not pay attention to your own posts that have the original unedited video but for some reason you felt you should reach back sixty pages to attempt to shame me and call it a "cover up". Had you not attempted to wrongfully embarrass me with your accustations of subterfuge no one else would have given it much thought because you have been free to post the original, as you have, multiple times, just as you are still free to do so now. Do your five (so far) listings of the original video not negate any clandestine operations you accuse me of? The apology I will give is to the readers and members. I feel that this thread is unfortunate and I do apologize for any misunderstandings or if I came across as rude. The true agenda of this thread is to tear down the merits of FUE and all that exercise it daily, a procedure that has already been through trial by fire during the early days of the online forum world where epic FUT vs. FUE battles have been waged. FUE has emerged, hardened from the experience, and validated by more and more clinics not only adopting the technique but converting to it 100%. Currently there is not a single reputable hold out doctor, that I am aware of, that is FUT only. The agenda of this thread does not stop with the teardown of FUE. This thread is designed to discredit FUE while another, initiated by Dr. Feller's new partner, is designed to introduce mFUE as the perfect patent pending solution to the problems presented in this thread by FUE. It would be too obvious to have both arguments in the same thread but if two separate individuals initiate the strategy from different angles then it is more easily digested. Call it the "good cop/bad cop" routine, again patent pending. To summarize what we have all learned: 1. No proof has been presented to show that the three physical forces described by Dr. Feller are insurmountable. None. There are no videos showing these forces, there are no photos showing these forces much less direct results of such forces directly tied into poor yield from any specific patient. 2. A "new" patent pending procedure has been introduced in the same time frame by Dr. Feller's partner that combines the "yield of FUT and the scarring of FUE" but Dr. Bloxham shares that FUE scarring is what people want while Dr. Feller says that FUE scarring is horrendous. I'm not clear on the difference but this is what is being stated but regardless of how you look at it, mFUE is here to save the day. 3. Dr. Feller did not make a single post, not one, between Janaury 2014 and June 2015. His account, "Dr. Alan Feller", had zero activity on this forum. When mFUE was announced by his partner, Dr. Feller's posting frequency rocketed through the stratosphere to discredit FUE. Why now? Why has Dr. Feller been completely and absolutely silent for a full year and a half before the announcement of mFUE, the proclamation of FUT being more popular than FUE, the mFUEvs.Stripvs.FUE thread, and the announcement of Dr. Blake now being a partner of Dr. Feller? 4. Dr. Feller attempted to create drama by saying that my editing of a video I posted sixty plus pages back, with the permission of Bill Seemiller, was a "cover up" like this forum had never seen before. This was said while five copies of the original, which I could have altered on Youtube at any time, rest untouched and unedited in his own posts. Did he overlook or choose to ignore? We'll never know. I will close in saying that I agree the tone of this thread should return to a more healthy debate but I believe it is clear that if a more amicable level of participiation can be achieved it will most likely devolve again once another disagreement erupts. I will personally do what I can to refrain from such problematic posting and I will simply stick to the facts as I have continued to endeavor. However, as a question to the readership; How many clinics can you name in the past year that have switched to FUE, either partly or in whole? Now how many clinics can you name that have switched to or incorporated FUT into their practice, partly or in whole? The answer is what it is, the truth. Good day.