Melvin- Admin

Stinger you really got to let your hair grow, unless Dr. Bisanga used 50fu per cm your density will always look thinner than the rest of your hair. Judging from your pics I'm assuming he utilized around 35-40 fu per cm, which is conservative but your results will look 100x better with longer hair trust me. U can keep the sides short that will make it look even better. Your results look great so far you've come a long way.

:eek: so right now Dr. Bhatti is offering grafts for $1.35?

Once they get educated that hair loss is progressive and donor supply is finite - then hell yes, I would hope they do have that mindset. I think the issue becomes that FUE only surgeons don't explecitly state that FUE results in less lifetime grafts than strip FUT. I certainly wasn't offered up this information at any of my consultations until I specifically asked. I think you are under-estimating the number of higher NW patients walking into procedures who can't quite get the coverage they hope for due to limited grafts. It also gets murky where it seems that with the exception of H&W and a few other strip masters, you could probably get a higher number of grafts moved in a one FUE mega-procedure (over 2 days) than with strip in a single session where laxity plays a role resulting in the need to wait a year to go again. But once again, this is short-sighted. I'm actually surprized the lifetime donor supply factor isn't brought up more in this debate. If its unlikely that lifetime grafts won't keep you covered, then why wouldn't you fight for every last graft? Like I said before, if getting a linier scar gets me an addition couple of of thousand grafts over my lifetime, and keep my head covered for an extra 5 to 10 years - then hell yeah!

 

I do respect your difference of opinion though

Mav,

Lifetime grafts do not change from FUT to FUE, because there is no universal donor zone, the safe donor area varies from individual to individual, a Norwood 7 guy thins everywhere on his head, a guy who will die Norwood 3 will not thin on the upper occipital region considered not safe. If an FUE surgeon reviews the patients family history, age, donor density, there is no reason why an FUE would have less grafts than an FUT. The only time this would occur is if the patient is extreme bald, in which case the same would be true with FUT. Universal donor zones are not universal.

They are not that unusual as H&W has quite a big portfolio of "Wow"results. But my point stands, has FUE ever produced results on par with that? That 20k graft case of Umar was not cosmetically on the same plane as these guys.

 

H&W have had patients from Spain and Italy, when they get to handle those hair types, the results are even more striking than what FUE practitioners do.

I disagree a complete restoration for guys Norwood 6/7 is not common FUT or FUE. Most guys don't possess the donor capacity. When comparing H&W results to let's say Dr. Lorenzo's YouTube channel, I still think Dr. Lorenzo has a better overall aesthetic result because there is no linear scar. In my opinion cosmetically a good FUT result will never be on the same plane as a good FUE result, because they don't have freedom of hairstyles, I personally don't like hairstyles that involve having your hair on the side longer than a two guard. That's just my opinion though, hairstyles like Joe, Dr. Feller might be suitable for some guys but it's not a style I would ever want.

Any updates?

HTsoon, when you refer to good cosmetic result are you talking about the length that the hair will grow or just the look/ feel of the individual hairs? I am considering using body hair as I feel that my donor area isn't great and also I buzz and will be buzzing my hair even after the HT so hopefully in this case the cosmetic look will be similar to existing scalp hairs. Another reason is I don't want to have a lot of visible scars on the back of my head as I'll have it buzzed.

It's not a good cosmetic result as a standalone, but body hair mixed with scalp hair gives a natural good cosmetic result, but if your going to just use body hair it's not gonna look good, your head will basically look like a hairy knee cap, the problem with using just body hair is that the follicular units per centimeter is no where near that of the hair on the scalp, so it will never look natural, if you buzz your head I recommend using all of your donor hair available then using body hair to add density, and if need be transplant some body hair to the donor area to camoflauge the scars.

Actually, to be fair, Lorenzo's work has been duplicated, by his colleagues Alejandro Chueco, Ximena Vila, Juan Couto, Erkan Demirsoy, Erdogan and others. Their work is great, however, a few things - their "showcase" results that are used as evidence for "FUE=FUT" typically employ patients with ideal donor hair characteristics. If you are a guy from the middle east, Mediterranean, or India with thick, dark, wavy hair, it could be a great fit. If you are a Northern European white dude with fine/average hair....you will not get those results! A lot of the Turkish clinics are doing patients from the Middle East, they have great hair types, so it works well for them.

 

None of them however have posted cases that match some of Hasson and Wong's best work, such as Bobman's result, or our recently banned friend Joe who used to represent them. Even Feriduni, a great FUE surgeon. Does he have an FUE result better than what Cueball35 got with FUT? (Also Feriduni)

Those guys you mentioned though are not the norm they are actually the exception, I think Dr. Umar (FUE) doctor had posted even more amazing results, but then again you're talking 20,000 grafts body and scalp.

I can't really see the donor scars, do you have any better pics, the growth seems poor though for sure.

Honestly I don't see the Norwood 6 or 7 pattern, most men who go Norwood 6 or 7 are diffuse thinners where you could visibly see the pattern, I'd say you're a Norwood 3V, I personally recommend trying lipogaine and nizoral shampoo, you can try finasteride but be very careful, at 25 your sexual health is 1000000000x more important than hair. Also combining the dermaroller with lipogaine has shown some good improvement. I'd wait maybe 3 years once you've stabilized your hairloss before getting a procedure. You still have a lot of hair this is the stage you want to fight hairloss, you can still retain most of your hair if you start right now.

Euro,

Take a look at this man. Did FUE give him the ability to "back out" of looking like he had a hair transplant ?

 

How would he cover that FUE donor extraction fibrosis ? The answer would be to grow his hair a bit longer. But that is the same exact remedy for concealing an FUT linear scar. The difference here is that the FUE recipient now has far more damage around the FUE scars because there are far more of them compared to FUT.

 

Choosing FUE as the "back out" procedure is simply not true because clearly this man cannot shave his head and pretend like nothing happened.

 

By the way, this is the NORM for FUE megasessions, not the exception.

This man with a "bad" FUE scar still looks 100x better than your average FUT scar, try again Dr. Feller

No I haven't told anyone besides my family and close friends, too many things people don't understand about hair restoration that I don't wanna answer like the shock loss, the wait time etc. people are under the impression you walk out of a HT with a full head of hair which is just not true. I've been lucky no one has noticed they just noticed my hair was a lot shorter, right now they're prob thinking I'm going balder, it'll be interesting to see what ppl say once the shock loss grows back and the transplant grows in, if ppl ask I'll prob just say it's rogaine.

Hey guys, I'm one month post op all of my transplanted hair has shed, my hair is short and looking like it did before my first transplant, this is a bit different from my first HT because my first HT was a constant improvement, now I'm looking at maybe 5-6 months looking like crap before the shock loss and transplant grow in. What do you guys do to mask this? Hairs to short for toppik at the moment, should I just shave it until my hair starts growing in? Hoping some of you seasoned vets could chime in. Can't wear hats at work cause it's a corporate job. I'm just staying focused on how it'll look once it's all grown in and the shock loss has subsided it's keeping me going but need to do something about this look lol.

Slight recession he's what 23-24 so yea he's at the age, I doubt he'll go bald though, isn't he Native American they have the best genes when it comes to MPB.

Is that the best you can add to the discussion

 

I saw your thread of your own FUE results. Very nice. Glad it worked out so well for you but what about the 3 or 4 guys on here who went to the same Doctor and ended up with miserable results? One guy seems very distraught.

 

Maybe you can tell us where it all went wrong for them? Just bad luck or could it be that FUE is less reliable

Ok I have to ask the miserable results is this your opinion? Because you said the same thing about my results even though I'm thrilled with my results. Results can be subjective, there are a lot of variables that need to be considered, current hairloss, hair characteristics, goals need to be realistic with either procedure, your not gonna be a Norwood 6 and expect to end up a Norwood 2 with one procedure. I really hope you're not just blasting other guys results for sake of argument.

Well they're not "three detrimental factors" that affect follicles but they are certainly " three detrimental factors" that affect the overall results and certainly would affect my self confidence. The first is the hair growing in different directions in the scar line? How is this prevented? Why does it occur? Second is the unpredictability of the scar widening, is there a way a patient can tell whether their scar will widen or stretch? and the third is the waste of valuable grafts to the scar region that could be used on the scalp, obviously though if there is a way to predict whether the scar will stretch there'd be no need to use grafts to the scar.

These three things have been the biggest reasons why I haven't chosen FUT I wear my hair short on the sides so the hair growing in different directions would be obvious with my hairstyle, the scar stretching is another thing i couldn't live with, and I wouldn't want to use my grafts in a scar, are you able to use body hair?

Bill,

The only way for FUE to improve is for new practical technologies to be invented. To date they haven't been.

 

I got the 75% number by simply looking at the results of FUE patients, both mine and others. Actually, I think the number is lower.

 

You are correct that we can't go into physicians offices and collect the data ourselves on growth yields. But we also can't look to patient results either because they are very variable in and of themselves. And, most importantly, we can't tell how many grafts were used to achieve a particular result.

 

The only way to evaluate where FUE stands with respect to FUT is to compare the procedures themselves. And that's pretty easy. Look at the Bhatti video and look at the Feller video. Look at the Lorenzo video, I've seen that bounced around too, and simply compare using common sense. The more in depth stuff is addressed rather deeply in my posts right here on this thread.

Wow you had some posters on here creating diagrams and graphs based off of a percentage you came up with based off of looks. You bring up a good point about comparing both procedures, but when I tried to bring up 3 detrimental factors in FUT it was swept aside as a mere distraction, I think in order to compare both procedures we need to review the good and bad from both procedures do you agree Dr. Feller?

Unfortunately I did not overcome the three detrimental forces of FUE. I diminished them a little through true and actual advances in instrumentation and technique, but not to the level of delivering an FUE graft that is as intact and uninjured as an FUT graft. If I had, I would only be doing FUE. But this is not the case.

 

The gold in your last post is that you are recognizing what I have been trying to say, and that is that if you are going to have an FUE procedure then you have to know, acknowledge, and consent to the reality that your grafts are going to be injured to a greater extent than that for FUT and will thus need more grafts transplanted to achieve the same cosmetic look.

 

The three detrimental forces of FUE have been identified and proven to exist, even if many FUE doctors refuse to admit it.

Torsion is evidenced by the immediate decapitation that occurs during the scoring process.

Traction is evidenced by the missing lower half of grafts that are removed, or lost parts of the lower half, or outright transection

Compression is evidenced by the crush injury that can be seen when the graft is removed from the scalp

 

All are in evidence and to try to minimize their significance is to go against 25 years of Hair Transplant gospel. Graft handling and preparation has always been at the heart of high yield hair transplantation. That doesn't go out the window because a few dozen practitioners decide it does.

 

In order for an FUE procedure with all it's involved injury to grafts to consistently produce results on par with FUT it must utilize more grafts during the procedure. The more the better. But this is only because so many are injured or killed in the process of extraction. Yes, you can point to a megasession recipient and say he looks great and thick. But he most likely needed more grafts to achieve that look because so many were injured in the extraction process. Specifically due to one or a combination of the three detrimental forces.

Well I put it in quotations for a reason it hasn't been proven. If it was proven I wouldn't use quotations. But nevertheless you bring up a point I'd like to have addressed, when you do scar repair and you do FUE do you take out more grafts than necessary? It would seem unnecessary with the amount of grafts needed. What you say makes some sense although again not proven in mega sessions, but how about small sessions of 1,000 or less grafts? For example the result you posted was impressive did you utilize more grafts than necessary?

We should install a poll what procedure would you rather have. Dr. Feller aside from the differences and even though I'm sure you don't like seeing my username come up, I think we've all benefited from this thread, especially your response on how to overcome the " 3 detrimental factors" I don't know why you wouldn't hone your FUE skill? It's hereto stay why not make it an integral part of your practice? With your vast knowledge I'm sure you'd become one of the greats.

I'll tell you how:

 

I utilized a very meticulous FUE technique to reduce the three detrimental forces.

 

1. I scored with a manual punch and did small angle oscillations allowing the punch to work it's way down into the dermis at it's own rate. No forcing in the name of speed. And certainly no rotary drill. This reduced torsion and heat.

 

2. Then I grasped each partially freed target graft individually and carefully and applied gentle but constant traction. This allowed the graft to work itself free at its own pace rather than being ripped out violently in the name of speed.

 

3. To decrease the traction force I slid a small needle into the scored opening and poked at the base of the still attached graft. This perforated it and allowed the graft to pop free with less traction and therefore trauma. See the video below.

 

 

 

 

4. Since I could apply less traction I could also apply less compression to hold the graft while delivering the graft.

 

5. As I delivered the graft I made sure to stay in the same line of traction the entire way. I didn't just yank and rip them out in any old direction in the name of speed. Nor did I attempt to score a bunch of target grafts and then try to grab them together as a clump and tear them free together in the name of speed.

 

6. Each graft was taken from the field one by one as they were delivered. I say "delivered" because I liken this procedure to delivering a baby. In child birth the doctor doesn't just grab the head with forceps and rip the baby out with great force because he has another birth to attend.

 

This is the technique that I use to deliver FUE grafts. In many cases it works well and the growth is impressive, even in a "hostile" recipient environment like a scar as seen in the repair case above. But even with all this caution and care patients may still fail to grow as satisfactorily as the equivalent FUT procedure.

 

This is why I say no matter how good or bad a result from FUE appears to be, the result on the same patient using FUT must be better because there isn't as much trauma to the grafts.

 

In the case of the FUE repair case above he happened to grow well. But if he hadn't, the chances are more likely that the decrease in growth would have been due to the three detrimental forces of FUE. If you can't overcome these forces then you have to get around them. The only way to do that is take more grafts than you otherwise would need to for FUT. And to do that you'd have to speed up your FUE procedure. And the faster you speed up your FUE procedure, the greater the detrimental forces are amplified. THAT, in a not so nutshell, is why I oppose large FUE sessions.

Doc,

 

In a previous life I gained a degree in Engineering at a reputable institution.... I wondered, is there not an adhesive force at the base of the graft that needs to be overcome? This puts the graft under Tension as well so is it not more than just 3 forces?

 

Compression

Torsion

Traction

Tension?

Good thing for us and the hair restoration community, Dr. Feller had been kind enough to give us a blue print on how to overcome these now "4" issues, The doctor himself has overcome these issues, the issues concerning the strip procedure though have yet to be addressed. If Dr. Feller is not willing to address them on this thread. I'm willing to create a new thread if he'll participate.

I'll tell you how:

 

I utilized a very meticulous FUE technique to reduce the three detrimental forces.

 

1. I scored with a manual punch and did small angle oscillations allowing the punch to work it's way down into the dermis at it's own rate. No forcing in the name of speed. And certainly no rotary drill. This reduced torsion and heat.

 

2. Then I grasped each partially freed target graft individually and carefully and applied gentle but constant traction. This allowed the graft to work itself free at its own pace rather than being ripped out violently in the name of speed.

 

3. To decrease the traction force I slid a small needle into the scored opening and poked at the base of the still attached graft. This perforated it and allowed the graft to pop free with less traction and therefore trauma. See the video below.

 

 

 

 

4. Since I could apply less traction I could also apply less compression to hold the graft while delivering the graft.

 

5. As I delivered the graft I made sure to stay in the same line of traction the entire way. I didn't just yank and rip them out in any old direction in the name of speed. Nor did I attempt to score a bunch of target grafts and then try to grab them together as a clump and tear them free together in the name of speed.

 

6. Each graft was taken from the field one by one as they were delivered. I say "delivered" because I liken this procedure to delivering a baby. In child birth the doctor doesn't just grab the head with forceps and rip the baby out with great force because he has another birth to attend.

 

This is the technique that I use to deliver FUE grafts. In many cases it works well and the growth is impressive, even in a "hostile" recipient environment like a scar as seen in the repair case above. But even with all this caution and care patients may still fail to grow as satisfactorily as the equivalent FUT procedure.

 

This is why I say no matter how good or bad a result from FUE appears to be, the result on the same patient using FUT must be better because there isn't as much trauma to the grafts.

 

In the case of the FUE repair case above he happened to grow well. But if he hadn't, the chances are more likely that the decrease in growth would have been due to the three detrimental forces of FUE. If you can't overcome these forces then you have to get around them. The only way to do that is take more grafts than you otherwise would need to for FUT. And to do that you'd have to speed up your FUE procedure. And the faster you speed up your FUE procedure, the greater the detrimental forces are amplified. THAT, in a not so nutshell, is why I oppose large FUE sessions.

I do not condone large FUE sessions I myself got my first FUE only 1,800 grafts split in 2 days. However, it appears from what you're stating that you were able to overcome the "three detrimental factors" based on skill, instrumentation, but at the end it looks like you said you took out more grafts than necessary to make up for lower yields. Not sure if you're generalizing here or speaking about your case specifically, it's interesting to read your response I don't doubt that's why you got a good yield, but it makes me think if you were able to overcome these factors than its not impossible for other physicians. Although it seems much more time consuming and tedious for a low amount of grafts, if this is true than I would say I'm in agreemeIMG_4425nt, I think for FUE to get the same amount of grafts as FUT you will need to do more surgeries, that is something you should know prior to electing the surgery, it's something that Dr. Diep told me in the beginning. But the single most important aspect of this post is that these factors, although not proven to exist, can be overcome.

On the flip side you have to wonder why the Atlanta doctor has not put the debate to rest.

 

All he has to do is get 20-30 patients post operatively, shave their heads close (he could offer a financial incentive) and then use a counter with a marker pen to count the number of hairs that grew, get the high definition pictures reviewed by industry colleagues and then publish the results. We could all bow down to the master of FUE.

 

...but sadly he knows the growth will never quite be on a par with FUT, and so do most of the top doctors operating worldwide.

 

To them it does not matter. They can screen their patients adequately to ensure a reasonable success rate, offer free touch ups if it goes wrong, or just put it down to a lack of x-factor.

 

As long as they get their $X a graft remuneration it doesn't really matter to them. The chances are they will have retired 20 years down the line when you come back needing another 3000 grafts from a decimated donor.

Studies conducted by one physician would never hold any bearing, it has to be studies conducted by a third party that has no financial incentive, he has a study that showed he grew 96 grafts out of 100 take it for what it's worth. That still doesn't answer the question as to how Dr. Feller was able to overcome the three detrimental factors on the result he posted in 2003, did he take out more grafts than necessary to make up for the lack of "growth" I'm very interested in knowing how he did it. As for as needing more grafts the same could be said about FUT there is no fail proof surgery doesn't exist MPB is progressive no matter if you're on finasteride with RU and minoxidil it still will progress and there is still a chance you'll need another surgery, so what if you're stripped out? You'll have to do FUE at the risk that the ugly scar will become visible but by that time the surgeon you went to will more than likely retired. The reason FUT doesn't die out is cause it's cheaper, and you can safely harvest mega sessions, with FUE you'll have to have more surgeries because it's only safe to do 2,500 grafts at a single time that's my opinion, but the overall aesthetic result of the surgery will always be superior.

Oh it goes far beyond inter-forum politics, online conduct and mere disagreements. I once shared the same sentiments.

Hmm pm me I'm interested to know.

The part in bold highly dubious...

He's had plenty of disagreements with other physicians, and this board, but that doesn't mean he's not reputable, even Dr. Feller with all of the disagreements we've had id still say he's a highly reputable physician. He's an IAHRS physician which counts for something, just like being a recommended physician on here. I know how you feel about spencer etc. I don't agree same could be said about Bill.

I know the doctor you mean who operates out of the state of Georgia. My doctor knows him very well, has visited his research facility and co-written research papers with him. He even uses some of the FUE tools (PCID) that he devised. He told me all about it the last time I visited Chicago...

 

..and yet my doctor also told me that FUE is not the miracle procedure it is made out to be (on the forums) and that the forces Dr Feller describes can be a real problem for some candidates, just a Strip can be a poor choice for others.

 

But I am not his spokesman so you can treat that as hearsay, however, you can always email him directly.

 

Those videos don't really tell us anything different to what Dr Bhatti is presenting, i.e. a picture of a wide abnormal scar having to be filled in with FUE. It feels like a bit of a marketing video for the PCID.

 

The pictures about hair angles either side of the strip scar has been brought up many times before. It could be a problem for some people if they keep their hair very short. But at the end of the day there are literally thousands of FUT cases to be viewed online that rarely (if ever) reveal this to be problem. In fact, I cannot remember a single person come on here for 4 years to complain about it.

The point I'm trying to make is that concerns regarding FUT have been proven, the "three detrimental factors" have not been proven, but even if they have Dr. Feller himself just posted an FUE case he did back in 2003 that showed an absolute fantastic result, so obviously he was able to overcome the "threes detrimental factors" my question to him is how?

Yes you are correct the physician I'm talking about does practice out of Atlanta and he's a well known and a highly reputable physician as well, the points he's brought up although they may be rare they still exist and should be brought up to laymans as a rare possibility prior to opting for FUT. I think we can all agree that the strip scar widening is unpredictable and happens often, the solution of implanting hairs to the scar actually lowers the amount of hair transplanted to the top, another valid point made by the Dr out of Atlanta.

That sums it up rather well.

 

Distraction, evasion, scare tactics, and personal attacks.

I haven't attacked anybody personally which is more than I could say about Matt, but that's besides the point, I'm really interested to know how you overcame the "three detrimental factors" when performing FUE in the scar, it obviously worked from the result you presented, that was great work.

 

Well I think we can all agree on two things:

 

1. This patient's scar is very very unusual and not even close to representing normal everyday FUT scarring. It's pretty obvious he suffers from a genetic over flexibility of the skin. If he's the same guy I saw in another thread the large wide scars even in the recipient site confirm that.

 

2. He is a PRIME patient for FUE and is, to my mind, the sole reason FUE exists. That is, to have an alternative treatment for patients who cannot nor can no longer have, FUT surgery.

 

I suspect even his FUE scars will be more prominent than in the average patient.

 

Considering the size of that scar, though, why not implant into it? That's the perfect scar for it. Standard FUT scars don't transplant well due to the fibrosis and lack of vascularity. These scars tend to be thin, less dense, and loaded with vascularity-or at least able to grew new vessels far easier.

 

Here's a presentation I did of the worlds first FUE into scar I did back in 2003. Worked like a charm:

 

How can you tell if a patient will scar like this? This brings me to the second point made from the physician that could not be mentioned here, implanting hairs to the scar wastes valuable hairs that could've been transplanted to the top. Furthermore, wouldn't the " three detrimental factors" still exist when transplanting hairs to the scar? hair growth is even lower when transplanted in to a scar, so wouldn't you be wasting even more grafts than normal?