JoeTillman

Thank you Dr. Feller but there was much more to my post than the point you highlighted above. I'd like to clarify my position. Strip first, then FUE if you are one that is seeking the absolute maximum amount of hair over a lifetime AND you have zero desire to shave or have a very close hair cut, below a #4 guard. I can barely hit a #3 guard myself but if I wanted to go shorter my donor scar would be clear as day but considering I've got ten thousand grafts you can't really ask for anything better and in fact to get this good would be fortunate for most to say the least. But here's the thing. I don't think anyone should have hair transplant surgery. It means that you always have something no matter how small it is, that is in the back of your mind. It can and does include the following: 1. Does anyone see my donor scar? 2. Does anyone see my donor scars from FUE? 3. Does anyone see the overharvested area of low density compared to higher density in the virgin areas? 4. Does my hairline look natural? 5. Is my crown covered? 6. Is my vertex covered? 7. Do I need more hair spray? 8. Do I need more surgery? 9. Is my Propecia still working? 10. Is my penis still working because I'm taking Propecia? So on and so on. The subconcious and concious issues that are floating in our heads become common place and routine but they are there and they would not be there without surgery, FUSS or FUE alike. I don't worry about my hair but at the same time it is still a "thing" that I am aware of. Is this because of my mental scars from my first two botched surgeries and from having a pluggy as Hell hairline throughout my twenties? Maybe, but it's there just the same. If someone is looking to have hair transplant surgery I try to routinely ask them if they have ever shaved their head. If they have not then I encourage them to try because if they like the look it will save them ten to forty thousand dollars. If they don't like the look then they can eliminate that option from their list. If one is going to get a hair transplant and they have taken every step possible to stop their loss and they are having a positive reaction to their efforts then they should evaluate what type of surgery that is best for them. Strip first then FUE is not a reality for many patients and I think in the grand scheme of things this path would be in the minority for most. If they know they are going to potentially wind up as an advanced NW and they do not like how they look with a shaved head then yes, strip first then FUE. If they want the option and think they do look ok with a shaved head but would prefer hair, FUE first all the way. This gives more of an option to tap out if they change their mind as long as the tools used are small enough to avoid the pock mark scarring that can result from larger punches and reckless overharvesting. With FUSS, one procedure is all it takes and there is no turning back. At. All. Ever. No amount of FUE into scar, SMP into scar, pixie dust into scar or a combination approach will ever erase a donor scar so if it can be avoided for most then it will be. This is where I believe that the somewhat lower yield of FUE compared to similar quality strip is irrelevant for most patients. I've said my peace for now so I'm going to try and stay out of this from here on out. My position is clear and I still have a lot of videos to edit before I hop on a plane for Turkey on Monday. I never imagined being my own boss would have me so busy!

Dr. Feller and Blake are correct in that FUE creates a larger overall surface area of scarring than does FUSS. I've seen this in cross-sections of donor strip tissue removed during FUSS procedures after previous FUE procedures were performed on the same donor zone. The difference is quite shocking actually as for each and every donor extraction with FUE you get a direct 1 to 1 ratio of scar tissue, albeit on a micro level. The superficial scar formation usually appears to be slightly smaller than the original extraction point but the math doesn't lie. 3000 FUE extractions using even a .7mm punch, on the smaller side of what most doctors will use, will leave a rough total surface area of scar tissue measuring approximately 2100 mm2. Even if the resulting scar formation from each extraction is smaller than the tool used to make it there is still a substantial amount of scar tissue.Take a proper strip to get 3000 grafts and, assuming a donor density of 80 fu per cm2 and a strip 1cm wide the length of the strip will be 37.5cm long. Assuming a 2mm wide donor scar once properly healed and you have 74mm2 total surface area of scar tissue. Many times you can take a shorter strip that is wider, say 2cm instead of 1cm, and the total scar tissue surface area is halved at roughly 28mm2 with FUSS. As I said earlier, the math doesn't lie but the problem is that the above math is only correct if the components of the equations are absolutes. Unfortunately in FUSS, absolutes do not exist across the board because no matter how perfect the routine is in any clinic; no matter how experienced a team may be, there is one variable that can never be nailed to perfection. The patient. This is why donor scars are not 100% predictable and why we see patients going in for revisions or camouflage, etc. regardless of who their surgeon was or what kind of stellar reputation they may have. Now, the degree to which the underlying scar tissue expands beyond the borders of the initial extraction are debatable and unquantifiable and will forever be a variable that can never be nailed down but both FUE and FUSS will have expanded scar tissue below the epidermis. What is not being discussed is how FUSS also has a diminishing return with each subsequent procedure. 1.The overall harvest diminishes, in my estimation, approximately 30% to 40% with each subsequent procedure, assuming max harvest is attempted each time and favorable donor scars are generated. This is due to compounding amounts of tension. 2. Donor scars often, not always, interfere with clean donor strip removal and the second donor scar rarely heals quite as well as the first. It can be close but the chances of it being wider than the first is higher to varying degrees. 3. It is my opinion that donor shock levels can increase with each subsequent procedure as tension becomes more and more of a factor to work with and tension, particularly in the mastoid processes, is the enemy. If tension is too high in this area shock will most likely occur and it doesn't always come back. Most of the time it does but it is not 100% for each and every patient. 4. With each subsequent FUSS procedure the distortion of growth direction in the donor zone increases as any transition of direction is removed thus leaving a sharp turn in the donor hair. This is a non-issue with fairly conservative hair styles utilizing lengths equivalent to a #5 guard or longer but if you go shorter then it potentially becomes more evident. I have this in my own donor zone at shorter lengths, around a #3 guard length but not at longer lengths. Does it bother me? Not really and no one around me sees it but it is there nonetheless. I could go on but the fact remains that Dr. Feller and Dr. Bloxham are correct in their assertions, there is more scar tissue formation in the donor zone from FUE than will be found with FUSS and there is no argument that is valid to the contrary. The question then becomes one of yield on subsequent FUE procedures. Does the yield decrease? If so, why? It is noted by some that when scar tissue forms in the donor area the peripheral hairs are distorted from their natural angles of growth and it can be more difficult to extract each follicular unit because of this. I have seen this too in cross sections of donor strip tissue taken after previous FUE procedures were performed in the same donor zone. Is it enough to cause an increased transection rate? Yes and no. I think this is what separates the experienced extractors from the inexperienced extractors. It is my opinion that the issue of reduced tension for subsequent FUSS procedures is mirrored in FUE by the slower pace necessary to navigate such issues thus reducing the total harvest in subsequent FUE procedures, not because of tension, but because the slower pace does not allow for the same number of grafts to be extracted as the first pass allowed. And the real issue is this. Most of what is laid out above, while entirely true and accurate, is academic for most but it ignores the elephant in the room, the reason why patients undergo surgical hair restoration in the first place. We can all point to cases left and right that support the back and forth arguments as much as we want; one guy's thinned donor zone is another man's stretched donor scar, etc. etc., but patients want the best cosmetic improvement for their appearance that is possible and in a growing number of minds having a strip scar is a step backwards from an otherwsie wonderful but flawed procedure known as FUSS and the way that the proficiency of *SOME* FUE clinics has improved (note that I did not say technique, because it is the same as it was 15 years ago), the trade off in lower yield is worth not having a strip scar for a lot of people. And to reiterate, I'm not campaigning against FUSS, not in the slightest. I still stand by my position that in order to get the maximum amount of grafts safely one should consider FUSS till stripped out then supplement with FUE but that is only if you can handle having a strip scar of any kind and you aren't fresh out of a bar getting your inaugural "I'm 21" cocktail and lapdance:) Many cannot but many don't care about a strip scar so it comes down to being informed of what the reality is behind each option available to the patient. That is my mission and why I'm not firmly on either side of the fence on these issues. Each procedure has it's merits and to be honest, the only merit of FUE is no strip scar and in every other category there is a potentially lower ROI than with FUSS to varying degrees. I am simply acknowledging the reality of the world we live in today by saying the truth is not always relevant in that no matter how good FUSS may look to a patient they will still choose FUE because of the strip scar. Period. End of discussion. Mic drops, exit stage left.

Blake, I'm fine responding publicly because it needs to be said but I don't want to derail this thread in doing so. The problem is that what I do is not easily defined. The easiest answer would be to say that the clinics I work with pay me a monthly retainer for my positive acknowledgement. The reality is that it goes much further than that but I'll simply say that I am a 100% pro-patient educator that helps clinics navigate the online world and work with them to find better ways to interact with patients, those that are happy and those that are unhappy. My alignments come from those that see value in my input, considers my recommendations and wishes to integrate my extremely unique experience. If I don't agree with their approach to begin with and I don't like their style then I won't work with them. It's as simple as that and is why no doctor I work with can expect me to blindly push their position on an issue if I don't agree with it and that is why I "screen" those I'm dealing with now. Screeing those that wish to work with me helps me to avoid any conflicts of opinion and helps to insure that we can have a good working relationship. One of my goals is to increase their business but I want to do so in an indirect manner that comes from positive overall recognition and for patient service both before and after treatment. The results matter but lets be honest; today there are more clinics than ever that do really good work so now, for me, the big difference is in clinic behavior toward the patient. Don't misunderstand however, I'm not saying there aren't clinics to be weary of based on results alone. Far from it but the chances of getting really bad work are greatly diminished with groups such as HTN to help patients along. I feel blessed to have several clinics contacting me of late and I am in discussions with some (not all) of them to learn more about how they do things. This means that if I like what I see then there will be more doctors I'll be making announcement about. I am not taking on clinics just because of who they may be or how much money they may be offering me. I'm taking on clinics that have what I feel are good values to do the right thing and a desire to do really good work without worrying too much about their ego. To me, ego is the enemy of real patient service because when the doctor is more concerned about himself than his patient then the patient lost before he even started with surgery and they don't even realize it. My goal is to help avoid this as much as possible and in order to do so, I have to be paid for my time.

Hi Blake, The Turkish data is insignificant as there are only 26 ISHRS members based in Turkey and I'm positive that in 2013 it was much less. By how much? I don't know but even at 26 members it is statistically insignificant. The stats were based on the then ISHRS membership only. I am, and I will continue to be as long as the relationship makes sense for us both. Dr. K is but one of maybe three or five doctors in Turkey that offer strip and FUE and I like that he has options for his patients but my freedom comes from not being limited to working with one doctor so I have no company line to push nor do I have the pressure to push a company line. That was my point. I drink water, the occasional beer, and red wine, not Kool-aid:) I will be announcing a new doctor July 1st in addition to Dr. K. so I'll have two doctors I work with that I happen to believe do not only very good work but also have other qualities that I feel set them apart. Yes, Dr. Karadeniz offers both procedures but the 2nd doctor I will be working with does not as he is strictly an FUE doctor. I won't go into another long post because we're agreeing on everything except one point. Where will strip be and where will FUE be in the future? My position is clear so it's not worth debating any longer and I have a butt ton of video to edit:)

Very nice work, Dr. Vories. Congratulations to you but more importantly, congratulations to the patient.

Hi Blake, First, you took my comment way too seriously. "Some" or a "few" doesn't matter, the point is that Turkey has some gems amonst a mine full of coal. And to put an asterik on my comment, the screen you are viewing this on isn't large enough for the asterik it demands! In my video series that I would just LOVE to be able to finish editing this year (sarcasm) I touch on this subject. And in the next several weeks I hope to have something groundbreaking, never before seen, that no one has ever presented regarding this subject. So, just to touch on this, you're right and I was saying the same thing. I'm not sure I get your point. You said an experienced surgeon would have moved up to 4000 grafts, he got over that at 4200 grafts but he went back for 2000 more. Who's to say he would not have wanted more with this experienced surgeon as well? Did the patient go back because of hair greed or because of low yield? Regardless, you can't compare the cost of two procedures to one procedure because you're assuming way too much. You assume too much my friend. The thinking is not that deep or structured. First, let me clarify for the readers. Blake is referring to what is known as "technician" clinics where the clinic has no real doctor associated with the procedure aside from drawing a hairline at most. Aside from that the technicians do ALL of the work from extraction to implantation of grafts into incisions that THEY make, not the doctor because the doctor is no where to be found. Blake is not talking about clinics like Karadeniz, Erdogan or Doganay as these doctors have a strong involvement in the procedure. The vast majority of clinics in Turkey are not like the respected clincs I mentioned but are like mills and there is an unofficial estimate of there being nearly 500 of these "clinics" operating in Turkey with half of them being in Istanbul alone. These types of clinics could not care less about doing a few more grafts to compensate for the costs. They care about making money. Why else would many of these tech clinics have one large room with between fifteen and twenty (that's 15 and 20) patients IN A SINGLE DAY?!!?!?!? Mo money, mo money, mo money. Period. Quality clinics like the names I mentioned have a much lower price than Western clinics for one reason. Economics. The economics of this procedure are much different in Turkey, and other parts of the world, compared to what we are used to in the West. Hair restoration is a normal part of life. When I was in Turkey the first night I was at a restaurant with Dr. K and five of the waiters had bad hair transplants. Were they horrible? No, they were ok for 1997 work but the point is that they were all in the same place and were had with waiter incomes. Where has anyone reading this EVER seen so many hair transplant results in a restaurant much less on the WAITERS? Point being, there is no inflating of graft requirements to compensate for anything. It's a money grab for many clinics, nothing more nothing less and when you have a small army of technicians cranking about over a dozen results, and way more, in one day it then makes more sense. The techs are paid peanuts and the owner of the cllinic is still making €30,000 or more every single day. Yes, I've removed grafts via FUE as well as BHT. I've also cut grafts under microscopes - no thank you:) They are fragile but not so much if you have experience with extracting them. Knowing which hairs are more fragile than others such as Asian vs. Caucasian, etc. but regarless, I'm not debating the issue of fragility or yield. I know grafts are fragile and I know that 5000 grafts would be impossible without some or even a lot of damage to the grafts but that is also why better clinics really don't push out 5000 in a day and instead limit most procedures to about 2500 to 3000 max. Erdogan does this. Karadeniz does this, Lorenzo does this, most everyone with a name does this. I do but my point was about the market not caring but yes, agreed. Agreed. If you take out 6000 with strip and you have a bad result you still have at least 2000 to do something with, maybe 3000 before you get into FUE. If you hit that donor with 6000 FUE first then it's time to tap out, you're done. I don't see this, in my tens of thousands of cases. Sometimes, yes, but I also see it with FUSS. The cases where I see either are in cases where the growth overall just wasn't that great but the majority of cases that I've seen where the growth was acceptable the characeristics of the hair seemed fine. There are always exceptions but overall I disagree with this particular observation. Fair enough but here's why I disagree. Again, this isn't based on preference, it is based on what I see as the cold hard reality. In 2025 it will be far more difficult to be in a position to offer strip because the opportunities to perform such procedures will be more rare but in order to perform them you'll stilll need the same amount of staff, not to mention space, equipment etc. As an FUE clinic you might have two technicians, three is you're busy. As a FUSS clinic, to do strip where it is worthwhile, say 4000 grafts, you need six technicians. What are you going to do with these additional technicians not performing FUSS procedures? Will they be part time and come in as needed? Are you going to pay for the additional space needed to house the unused microscopes, the unused additional support materials etc.? It goes back to the economics. It is more cost prohibitive to perform FUSS and this becomes an ever harder fact of life when your FUSS procedures are sprinkled in between FUE procedures every once in a while. And with that I too am anxious to see the results. I hope you have clean shaven mFUE results to share with properly taken photos. I have my doubts which I won't mention here (unless you want me to) but I'm trying to keep an open mind about it which is all anyone can ask for. Consider my position in all this. My life has been dominated by the shadow of the surgical hair restoration industry, starting with two bad strip procedures at the age of 22/23. Nine years later, as a full blown NW6 with a pluggy hairline and nothing behind it AND two stacked donor scars, I finally got repaired. Not by FUE as it wasn't well known back then but even if it were FUE would not have done much. FUSS was the only option and I would not change that or my experience with Dr. Wong for anything. I then worked for a clinic that eventually became arguably the most famous hair transplant clinic in the world, for eleven years no less and after a short stint with another, just about equally as famous clinic, I'm independent but more importantly I'm a convert which is ironic since FUE is the only thing I could have now if I wanted more work performed (anyone? anyone?). The point is that I have much less to gain from debating in FAVOR of FUE than just about anyone that actually works in this industry because surgically, FUE has done almost zero for me personally and FUSS has saved my life and even given me a new life and a new career. I am in a position where I need absolutely nothing surgically. But I am also in a position where I drink no Kool-aid and I have no financial advantage to saying anything except the absolute truth based on my experience and in that experience, with zero influence from anything but that experience, this is the all encompassing reality, in my opinion. 1. FUE has less yield overall compared to FUSS with varying degrees of severity, all things being equal, patients, doctor skills etc. 2. Patients do not care. Patients do not want strip once they have a second to realize that there is FUE and I don't have to tell you that the majority of cases you speak to, that are considering you for surgery, have to have the merits of FUSS explained to them, usually more than once and I absolutely guarantee that when strip is pushed too hard on someone that comes to you for FUE you wind up not hearing from them ever again. I guess that this is a fact for most all clinics that offer FUSS to this day, unless the patient found them in the phonebook or a referral and not online. If this wasn't the case, mFUE would not exist, because you are catering to those that do not want a strip scar thus there can be no debate about why strip will disappear. You and Dr. Feller acknowledge this by your own actions, the creation of your mFUE punch. I hope it works out because I believe in options so I look foward to what you and Dr. Feller have to offer.

Since I'm being mentioned as a point of reference I should chime in to clarify my position. First, I know Dr. Feller. I like Dr. Feller. I think Dr. Feller is one of the better hair transplant doctors. But my position is one that I think Dr. Feller may not agree with but I also know he respects that. FUE is growing. It has been for years and it was at the 2013 conference in San Francisco when I saw the real writing on the wall. I knew that FUE was going to get stronger and as early as 2010 I ceased being so negative in general about the subject and started to be more complimentary but with the facts laid out as they existed, and still exist, in that the yield will generally be lower, sometimes by a lot, sometimes not, than when compared to FUSS. And before anyone decides to chime in on this to debate this issue, don't waste your time. It cannot be proven one way or the other and it is something that I believe from having seen, oh, I don't know, thousands of heads AND because I don't have a pro-FUE or pro-FUSS agenda. Being a free agent affords me this freedom. Anyway, the program for the conference showed all of the discussions scheduled and an overwhelming amount of discussions were regarding FUE. 78 were FUE only. 12 were FUSS and those were more like comparisons of FUSS vs. FUE. The only presenters regarding FUSS were the old guard, those that are most established in the industry for their FUSS work and happen to be getting overlooked now in favor of more recognized, modern FUE clinics. The ISHRS ranks have swollen to where membership borders near 1000. This is nearly twice as many people as ten years ago. What I saw at the conference were some familiar faces but the majority were young, new and most likely not performing strip. Statistics quoted at the conference said that on average two new clinics are opening to perform surgical hair restoration, worldwide, every week. It is my opinion that these are not FUSS clinics and as those that perform FUSS switch over 100% or retire, and with the lower overhead and startup costs of FUE, FUSS WILL eventually disappear. The statistics in 2013 were that approximately 1/3 of all procedures in the ISHRS membership were FUE procedures. With the expected rate of adoption, either in existing clinics or new clinics, I predict we'll have FUE at parity with FUSS worldwide by 2017 or 2018 and then FUSS will begin to be the minority procedure with a rapid observable decline by 2020. By then, FUSS will be rarely spoken of. The above, save for my prediction, are facts based on the ISHRS membership sharing their information with little room for debate. This does not mean that Dr. Feller is wrong on his position. I happen to agree with much of what he says. What I do not agree with is that FUE results are rarely good (if he did say that, I didn't read that part). I've seen many many exceptional results and I'm not referring to online only. My recent trip to Turkey and Europe showed me this in addition to the many patients I speak with on a weekly basis. In fact, I've seen great results for a fair amount of time now. When I went to work for Dr. Rahal last year I was given access to a trove of FUE results that are not published that helped to nail the issue shut for me. But I digress. As was said earlier, a hybrid approach is the best way to maximum graft numbers and FUSS alone is the best procedure for many repairs. FUSS is always the most efficient manner in which to get the maximum # of grafts if one had to choose between the two. Technically more can be removed via FUE as one can have their donor zone plucked clean like a Xmas Turkey but one must think of the cosmetic threshold that FUE can easily, and often does, overstep. I'm a walking billboard for the merits of FUSS over FUE as there is no way in Hell that I could have had the repair I had with FUE alone. Not. Going. To. Happen. Ever. Period. I'm stripped out now and I've got about 1500 scalp FUE remaining. Hybrid = good. The reality of FUE vs. FUSS is simple. FUE has gotten to the point that people do not care about the yield disprecancy. A few percentage points of lower yield is preferrable to a strip scar for many, if not most, patients. No amount of debate, no number of videos, no degree of fervor will change this. FUE is not only here, it is growing, and FUSS is leaving and in my opinion it will be relegated to a statistically tiny number of cases where FUSS has the clear advantage and is still practiced by a few FUE doctors that remember how to do it. It is just like the Betamax/VHS wars in the early 1980's. Betamax was the superior technology but the public had access to the lower priced, but not quite as good technology, found in VHS. The rest is history.

Hairjo, They hear how great Turkish clinics are because some Turkish clinics are pushing out very nice work for a 1/3 of the cost, at most, compared to Western Euorpean and North American clinics. It is a simple lesson in economics. If you offer a product that is even only "almost" as good but for an disproportionate amount of money LESS then it will sell and it will sell well. The degree of shilling found onilne is unfortunate but it is not much different (but still better) than the clinic wars ten years ago.

A few issues... Whom was it that you were speaking to that had a master's degree that is relevant to micro-pigmentation? I've never heard of such a program. I have no "team" but my information does indeed come from speaking with permanent SMP clinics and from meeting patients. Me - "How long does the SMP last?" SMP Clinic - "It lasts for five years before you need a touchup". Me - "Oh, ok. How long have you been offering the procedure?" SMP Clinic - "Two years.". I don't get it. First, who are you speaking about? Who is being paid to document "year to year"? In addition, who cares? As long as the "tracking" of their progress is near real time it doesn't really matter if they are being compensated because a few dollar bills can't mask a bad result. I think that any compensation should of course be stated as transparency is important; but still, who are these people? Ten??? That had SMP OVER ten years ago??? Are you maybe exaggerating just a wee bit here because that is a massive number of people, that you could personally find, much less speak to, about their scalp micropigmentation experience. Ten years ago would mean June, 2005 at the latest so that would give you a window of six months where ten people would have to have had the same procedure, that you can find, and speak to from a time when almost no one was performing scalp micropigmentation. That is simply outstanding detective work! Pointillism is not difficult? No, I suppose not, but to perform it to the level that naturalness can be achieved, and based on what I've seen in the industry, it is extremely difficult. I get it, and I would never question your, or anyone else's happiness with a product but you have what appears to be a very negative temporary SMP attitude, contrary to your statements indicating otherwise. On the flip side, I have no problem with permanent SMP as long as the patient knows the FACTS in that your experience is your experience but there are those that have had moderately bad to horribly bad experiences in which their scalps have been left negatively, and permanently, altered due to permanent SMP procedures. That too is a fact. What is also a fact is that there is not one documented case of a temporary SMP patient having the same problem. Not one. So unless you are naming your clinic as the one to go to, and the practioner as the practioner to go to, then I don't think you are in a fair position to give your opinion in a blanket fashion, that permanent SMP is a better option. It was better for you, with your provider and your practioner, but I think you'll agree that there are far too many scam artists, and even SMP providers that think they may be doing good work, that are, in reality, doing work that neither you or I would want our our heads. That is why I don't say all strip hair transplants are the best. It was the best for me, and with my doctor, but there are other doctors out there that would not do such a great job on me or anyone else for that matter. It's the same difference. And yes, SMP is a money making "machine" but so is a lemonade stand. It's called capitalism and as long as a good product is being offered, and the patient understands the reality of that product, then nothing bad can be said about it. p.s. I'm not editing photos. I'm editing video.

A comparison? You wanted to see what trico looks like at one year so I thought you wanted to judge it for what it looks like, not what it looks like compared to a fresh procedure. The above patient is at roughly one year so the question is, how does it look? I'll see if I can find the "fresh" result pics. I'm somewhat overwhelmed at the moment trying to edit over 100gb of footage from my trip and I'm trying to knock most of it out before I hop on a plane and fly back to Turkey next week:( I have a question for you in the meantime. You're asking about how tricopigmentation looks as it fades, which is a fair request. My question to you is, did you ask the same of your SMP provider, to show you how it looks at five years? I say five years because this is about what most of the permanent SMP guys say when asked how long it lasts before a touchup is needed. How about seven years? Or longer? I can't really find much in the way of actual long term results when I do a search online so maybe you can point us to where such results reside. This too is a fair question since most of the clinics that say that permanent SMP needs a touchup in five years have not been performing the procedure for five years so it is interesting how they know such things.

Who did your first surgery?

Roughly one year post-trico with Milena.

Hi Mickey, The donor scar turned out excellent and there is a part of the video I shot that shows a clear and substantial improvement where the stretchback section is easily seen next to the revised section. I will try my best to have the video ready before I go back to Turkey next week for the conference.

He's wearing a wig, period. If he weren't then the scalp would feel normal unless it was horrible procedue with bad scarring and pluggish looking grafts but even then most bad jobs don't feel like you described it. It is looks normal, as it appears to be from your tone, then it's a wig. My opinion on this is, if you don't care then don't care. Let him live his life the way he chooses and it is not your place to try and "coax" this information out of him. Women always want such openess from their man until they get it so do him a favor and don't set him up for failure by pushing him to be open about something he obviously does not care to be open about. He'll tell you if/when he wants to tell you.

I was fortunate to have met this patient when I was in Istanbul last month and the improvement from his before photos are not justified in his after photos. The man speaks with confidence and his energy exudes a gratitude to Dr. K that I've been fortunate to see before. I also shot some video and when you see the donor scar result, from the side that Dr. K worked on, you'll see one reason why the patient is so grateful for the work performed.

Hi Blake, Yes, I've got a Q&A session with Dr. K that touches on this subject. I'm also outlining an article on the subject that will be written at a later time. The point about the waiters, yes, that had to do with the low cost of entry into the procedure. I'll reveal more soon.

Thanks, fellas. Sometimes I need to stop myself when it comes to ideas because in cases like this I have to question the effort necessary to pull it off. It's one of those things that are difficult to pull off but once it is all done it becomes very satisfying. That is what I keep telling myself, anyway:) I did not realize the volume of footage I'd be shooting, much less the volume of data that it would amount to for my hard drives. When you shoot in HD, and shoot photos in RAW format on two full frame DSLR Nikons, the hard drive space adds up quick. In total, I shot over 120gb of footage and about 12gb of images. The good thing is that I have learned tons and the next shoot I do for the next doctor I take on will be more efficient. To say I've learned a lot so far would be an understatement. Mr. Matt, Your question is one of the reasons why I shot this documentary. It is because we see people talking about going to Turkey but not talking about the journey for their surgery that we don't think about what is involved. Coming from the UK or other parts of Europe or the Middle East, it is a fairly simple journey save for the additional security and scrutiny that can be had for foreigners traveling to the area. For those coming from areas further away, such as North America, not so much. I found it more difficult getting out than getting in. I think the cost is a no brainer. If you find a doctor that does good work then the price is easy to swallow because the cost allows for an equivalent sized session with a top doc in Turkey and one still has change left over. To be honest, after having had a crash course in Turkish hair restoration and being exposed to the concept of Turkey and hair I have a hard time wrapping my head around the costs associated with hair restoration in North America and western Europe. It's that cheap and is no longer a shock to me. For the cost of a 2000 graft surgery in North America you can fly to Turkey and back and still save about 40%. Lodging is included with most clinics, including Dr. Karadeniz as well are airport transfers to and from the airport. The only thing you really pay for is the food you eat outside of the clinic and your ticket to the region and the 40% savings I mentioned includes all of this. The question is, is money the only thing that matters? I don't know of a lot of people that would take on a journey like this as they would prefer to stay closer to home in case of complications or they just like the security of staying in their own country, which makes sense. However, medical tourism is a 5 billion US dollar industry for Turkey and hair restoration makes up a big part of that so obviously a lot of people are going there. This first video is designed to help people see the trip for what it is and not with a bunch of fluff with church bells, rose petals and warm meditteranean wind being blown up our collective arses. This is real, as real as it can be without having a 16 hour account of the journey. When you travel most anywhere in the world, you'll find that English is the common language. It is the language of business worldwide and most everyone working in major airports and mid to upper level hotels will speak some proficient level of English. The streets are different but overall it is not difficult to get around in any country I've been to because I take some time to learn basic questions and phrases about how to get around. Combined with hand gestures, finger pointing, Google translate and some luck it is not very difficult to get around no matter where you may go. Blake, as you'll see in the upcoming videos, Dr. Karadeniz is indeed a no-nonsense kind of guy. He's a scientist at heart and a real hair geek. He surprisingly has little to no ego and asked me multiple times to critique his work for input. One thing that impressed me was that after some conversations we had about punches and techniques he had his punch maker make some new punches based on our discussions and he started testing them immediately. That's one thing I like about him, if he thinks there may be a better way, he tries it. It is works, he switches and adopts. If not, he doesn't.

Here it is. After finally getting home and losing a full week of productivity due to a serious flu bug I caught I have finally put together the first in a series of videos showing my hair transplant documentary in Turkey. This video applies to anyone flying to Turkey for any clinic as there is nothing unique to Dr. K in this first video. We all read about patients going to Turkey but we never think about what it is really like to actually go to Turkey. This will help shed some light on the process and experience and if you do wind up going you'll have a bit more comfort recognizing familiar things that you can see in this video. It's long, and is a cumulation of short clips I shot on my way. Stay tuned for more! https://www.youtube.com/watch?v=cTYG13ppJvI

Beard hair transplantation is a growing trend. When I still worked in Vancouver (in an office) I was interviewed by one of the local stations about this very issue. The procedure itself is not new and has been performed for several years but with the growing "hipster" movement at the time the procedure was getting a lot more attention by the media. There is no "BDD" issue for these guys, at least the majority of them. If the work looks natural, which it does in this case, and the patient doesn't have a need or a desire for the same hair to be placed on the top of the scalp to address balding, then I see nothing wrong with this. It's a good procedure and in this case it is justified.

I think this is an excellent result, one that I would never pick out in a crowd. Well done!

FUEguy, You first asked... I replied... You then asked... Did I misunderstand the question? Why are you asking me twice?

Pardon me, Dr. Feller. Which video is this that has 1500 views? I see your mFUE vs. FUE vs. Strip video with 162 views at the time of this post. Is there another on the subject I'm mssing?

FUEGuy, The point of my post was to address an inaccurate statement by Keyser. I appreciate your comments about me being a useful resource but I'm trying to do things differently. This post directly implies that I will only recommend a doctor that is paying me to recommend him/her when in reality nothing could be further from the truth. I'm not being paid to be a consultant, I'm being paid to help his business which, by proxy, means he'll get, and is getting, more patient inquiries. If this means, and it does, that patients will be asking about doctors I work with then great, I'll give my opinion and how it applies to them but I'll give (as evidenced by Mav23100gunther) the advice I think is best for the patient, not what the doctor tells me I should be saying is best for the patient. To do this would be selling out and wasting my knowledge and experience. What I'm doing is very unconventional in the hair restoration world. I'm not running a "recommended" list and I'm not a consultant. Rather, I'm somewhere in between but I don't expect everyone to understand. If I were simply offering myself as a consultant for hire I could not stomach being in this industry any longer. Been there, done that and I want nothing more to do with it. For myself, I'm in a position where I can educate about the reality of surgical hair restoration without having a doctor looking over my shoulder. I'm free to innovate and offer educational tools and resources like no one has. For doctors that meet my requirements on a number of levels and feel I can help their clinics, they get my insight and know how and a listing as someone that I feel has more than just solid surgical skills but solid ethics and solid patient care (or wants to have). Great results are being performed by a lot of doctors but few give a damn enough to take care of patients after surgery has failed unless the patient screams online. That's wrong and I'm determined to find those few and help them get the attention they deserve, among other things. I'm sure this will come up again but let's save it for another thread. This thread is already weird enough.:eek:

I was speaking to a friend of mine that is also in the biz. I told him that I think it is to the point that a comparison can be made to the VHS/Betamax wars of the 80's. Betamax was the better product but VHS won due to cheaper implentation and volume. Same thing with strip vs. FUE. Strip has a better yield, all other things being equal, compared to FUE but the cost of entry to FUE is much lower and the volume of clinics taking it on is exploding thus strip is the Betamax of our time. I like strip, it works and it's reliable in better hands and I think that many patients benefit greatly from it. I'm a walking example of how strip can sometimes do what FUE cannot but I think that stunts like the one referenced here are ridiculous. Better strip clinics should just continue to do the best job they can and the patients that recognize the benefits and understand the shortcoming (singlular) will opt for it. Desperate games like the one above are not necessary.

Agreed.