adonix

So this is worth a watch:

 

It's Dr Lorenzo's extraction and implantation technique from a few years ago. From my perspective, he seems about as good as it gets in terms of technique. But I think anyone would be hard pressed to say it negates the three forces Dr Feller talks about.

 

And I add above the caveat 'from a few years ago' because it seems he doesn't do all the extractions himself now, so this won't necessarily be what you get from whoever does - though I'd assume he has provided good training for whoever does it.

Arent Lorenzo's results proof that he negates the three forces on consistent basis?

He does most extractions himself even now.

I am in both camps.

 

And I have performed many FUT procedures on patients who have had FUE prior. Here are my observations:

 

If the patient had FUE in the first surgery, particularly greater than 500-700 FUE, then the implications for a second via FUT are decreased yield. This would be due not only to absence of the follicles that were obviously extracted in the first surgery, but also to the fibrosis and shock loss of the hairs BETWEEN those original FUE extraction sites due to FUE trauma. Many of the remaining hairs would also be partially traumatized decreasing their chance of surviving an FUT procedure.

 

It would be harder to numb the skin and the bleeding would be greater. This is because along with fibrosis comes an over compensation on the part of the body by increasing the amount of blood vessels and nerves in the damaged skin of the donor area.

 

It would be harder to dissect under the microscope because the ubiquitous fibrosis will have infiltrated the entire strip disrupting the normally parallel orientation of the follicles. Also, the resistance of the skin will now be more variable making it yet again more difficult to cut as the blade may now shoot through the tissue instead of a slow and controlled glide.

 

Finally, there will be more postoperative pain as those extra nerve ending fire. I've seen all of this many many times and have read the accounts of other patients who have also reported all of this online.

 

I remember speaking with Dr. Hasson about this years ago and his words were "FUE destroys the donor area. Absolutely destroys it and makes a mess". I can confirm that observation word for word.

Noted and thanks.

Just like every other patient, I am only interested in getting the best result possible with minimum risks.

A friend of mine had FUT. His scar is ~2mm at most, meaning fantastic by FUT standards. However he cuts his hair very short and when I first saw it (I did not know he had a HT, nor much about HTs at the time), it looked scary. I thought he had a brain surgery.

I am of opinion that if a reputable surgeon is chosen with a proven track record, FUE can provide similar results to FUT. Are there risks? Of course, but I personally see more risks with FUT. If I can get 6-7000 grafts with FUE, good enough for me + I can still cut my hair very short.

 

Dr Fellars FUE, I can't find any

 

 

Here is one of dr. Feller's FUE cases (~2000 grafts in total, much larger than 700 grafts he claims as acceptable)

http://www.hairtransplantnetwork.com/blog/journal.asp?CopyID=5942&WebID=1787&ProcID=4023

Wow! Another one.

Dr. Feller if one has FUE and decides to go for FUT for the 2nd surgery, what are the implications?

Not a "gotcha" question, since this is something you could advise based on your experience. Please forget FUT vs. FUE camps for a second.

Dr Feller, is this one of your pencil thin scars?

I think the question is very strait forward and he will answer it or it will make all he had written irrelevant!

Dr. Feller will not answer to any relevant questions. He is too scared of being sued, so he only likes to talk about FUE.

I mean the guy does not bother measure the surface area of the mFUE punch, yet he claims it produces "FUE like scarring". If that is not a total negligence, then I don't know what is..

Dr. Feller, is it ethical to advise a patient to do a 1500 grafts FUT? Is it good for a patient to get FUT scar for only 1500 grafts?

I thank everybody for their input, harsh as much of it is in my opinion. But you are participating and we can't have anything without that.

 

While I don't agree with much of what has been written by the "peanut gallery" at least I know this topic is being circulated and read throughout the world.

 

I have read all the questions suddenly being asked of me and I absolutely will respond to them because they are very easy to answer. However, I ask that you focus on the specific interaction between me and the two FUE doctors and limit your questions to the topics that we are discussing.

 

For example, I asked Dr. Bhatti a simple question. Do the three detrimental forces of FUE that I described (Tortision, Traction, and Compression) actually exist? So far he has not answered that question. If any of you have a question about that particular issue then I would be happy to answer it while we wait for the FUE representatives to chime in.

 

If we don't do it that way the topic will branch off in multiple directions and nobody can keep up with that.

 

If you have questions that are important, then create a new topic so that they can be answered there. But let this thread be an open dialoge between the representatives of the FUE megasession side and the FUT/small FUE side.

 

Does that make sense?

It doesn't make sense. You can't pick the way a debate goes. You are either in and respond to all pros and cons queries, or you are out.

If it is easy to respond, then go ahead and do it.

Fortune,

Thank you for your posts and observations. I think you have understood what has been going on all along. I would be happy to address crown balding, but not on this thread or at this time. I want to keep this focused on the debate. And as of now we are waiting for Dr. Bhatti to answer my first question declaratively and in depth. And to respond to my rebuttal of his question that you mentioned here.

 

By the way, I agree with you that the issue brought up by Dr. Bhatti concerning donor extractions and recipient sites is intuitive. Is there any FUE practitioner viewing this who doesn't see it as intuitive that punched donor area extractions are not the equivalent of recipient area site slitting ?

 

Dr. Bhatti, do you have any comments or questions about your confusion in this matter?

 

Thank you Fortune.

Dr. Feller you are missing the point. The thread is about FUE vs FUT, which includes all aspects of both approaches, including potential stretching of crown. You keep avoiding all negatives about FUT, and keep promising to address them at some other time.

Nevertheless, this is the thread and time to address those concerns.

So dr. Feller, what is the surface area of the mFUE punch?

Actually he is smarter than the average forum visitor. He is a qualified doctor with a PHD! what are you?

Based on his posts - he is not.

What am I? Well that is a good question, lets say I am more educated than dr. Feller, for starts. But then again, education means nothing if one allows ego to take over.

Then why did you make an explicit statement that FUT having an advantage is simply not true? you just admitted you have no records to prove either side, so for you it's simply unknown, therefore FUT having an advantage could be true, no?

No, i just said that there is no proof to say that either FUE or FUT have advantage.

 

Originally Posted by DrBlakeBloxham

Bill's mFUE questions:

 

1. Approximately how large are the mini-strips that are being harvested? How wide and how long?

 

It depends. Don't you love that answer? I never specified a size of the punch grafts we take with the elliptical punch because it's not round, so the only way to fairly compare it to a round punch would be to compute the surface area. I don't know if anyone here has ever tried to calculate the surface area of an ellipse -- I hadn't -- but it's not fun.

 

The circular punches range in size. Just like traditional FUE punches do. They are several millimeters in diameter. We are still trying different ones to find that "sweet spot" where we maximize grafts and minimize scarring. Dr Lindsey found his initially, but then he started experimenting with the elliptical punches more.

 

However, we are using round punches for the two larger mFUE procedures we have coming up.

What kind of excuse is that, "it is not round"? How about you provide width of the punch and height at the largest point? Most of people know how to calculate the surface area of an ellipse and will be glad to help you.

The fact that you had not bothered to calculate the surface area of the punch you use is very troubling to me - if you dont know the surface area, how can you:

1. estimate the potential damage it would do to patients donor?

2. predict scarring?

3. claim the scarring will be comparable to traditional FUE?

Weird..

Dr. Vories,

 

Since an implanter pen can be used for either procedure in exactly the same way it cannot stand as an advantage for FUE.

 

If, however, it did impart some sort of greater protection for the implantation of injured skeletonized FUE grafts, then this heretofore unknown benefit would apply to an even greater extent to an uninjured FUT graft, thus giving the advantage once again to FUT.

 

I understand that your point in using the pen is that it somehow will compensate for the injured FUE graft. But my point is: isn’t it better to not have the injured graft in the first place?

 

The graft is injured due to varying levels of particular and predictable damage inflicted exclusively during the FUE procedure, namely Torsion, Traction, and Compression. Wouldn’t it be better to just avoid these destructive forces altogether?

 

I look forward to your considered reply and thank you for joining in the discussion.

 

Dr. Feller

"injured" "skeletonized" "detrimental forces" "gold standard", such transparent manipulation tactics..

Dr. Feller, with all due respect, you think that you are smarter than an average forum visitor. Unfortunately you show time and time again that you are not. Even an average person, able to read between the lines, can see what you are trying to do..

Do yourself a favor, lose arrogance, support your claims with evidence, provide top-of-the line care to your patients before and after surgery...

Maybe you should follow H&W path, provide high resolution photos, follow up with your patients, etc. and you will not have to worry about the future of your business so much..

Hey Adonix,

 

Wanted to share something that may be helpful:

 

Dr Wesley and Dr Beehner, both FUT and FUE surgeons, shared data about the yields and rates over the past few years. In fact, Dr Beehner did this in the exact manner you suggested: by following up with patients who had the procedures and objectively comparing the data.

 

Here's the info. Hope everyone finds it educational:

 

6 patients, seriously?

What if 0.85mm punch is used?

Have they used the implanter? How often they do FUE vs FUT?

So you have verifiable records of FUE having an advantage?

No, I dont. That is the point. There is a need for more research and more records.

Until then, this is all empty talk, or even borderline greed by some surgeons who are worried that their business model is not so appealing anymore, etc.

Why is FUT not having an advantage simply not true? How do you know this as fact?

Because i dont see any verifiable records of that.

I would like to propose to surgeons to do follow ups with patients after 1 or 2 years and measure hair count in transplanted areas.

No excuses, make it a part of your practice.

My definition of "better" is which procedure would provide the most hair and aesthetic coverage over the course of an average patients life who needs every single graft available to him, has average scalp laxity, and qualifies equally for both procedures. Let's also say that he is deciding between FUE only or FUT until stripped out, and then switching to FUE once stripped out.

I think that is becoming less about the type of surgery and more about your donor and the choice of surgeon.

Some FUE surgeons claim 7-7,500 grafts can be extracted from a good donor. FUT surgeons claim they can extract 7-7,500 if there is a good laxity.

If FUT was really the "gold standard" then almost every patient would get 90%+ yield, and FUT would have an advantage. However that is simply not true.

Cali / FUE2014 - all fair points, not trying to be disrespectful to Dr Bhatti at all, and apologies if I came off like that, the politician statement was probably inappropriate. Just trying to say what I feel because I really do want to hear both sides with an objective view so that as an average patient with little real knowledge of this stuff, I myself can make an informed decision.

 

So far all I have really heard to date, is that FUE is performed with extraordinary success in the hands of Dr Bhatti (I never disputed this myself, and know it to be true, just take a look at David's progress to date) and that he made the decision to switch his practice to FUE exclusively. I think he is implicitly stating that the three forces are overcome or mitigated in his own hands due to patient selection/screening, but I am still not hearing whether FUE is a better procedure over FUT when a patient has great donar laxity and qualifies for both (push the linier scar to the side for a moment, because we all know that's a big con to FUT). I'm really hoping to hear more from Dr Bhatti on this. No disrespect at all, promise!

What is the definition of "better" to you?

Yield? I saw more excellent results from dr. Bhatti's FUE than dr. Fellers FUT.

Natural look? Did not see unnatural results from leading FUE surgeons.

Post op care and recovery? Lets not even go there.

Scarring? See above.

What is problematic with your posts is that you talk about dr. Feller's FUT as if he did a 5 year study, comparing his patient's pre and post op hair count, quality of hair, etc.

He did not, in fact he has no records to support his claims of "gold standard", "higher yield", etc.

Dr. Feller rarely posts pre-op and post op high-definition photos, and he had his share of low yield results and stretched scars.

Dr. Bhatti,

First I want to thank you for engaging in this discussion. You are the very first and only to do so to date. So your participation is noted and appreciated.

 

I want to get into the points you made in your previous posts. But I want to proceed step by step so that these posts don't become ridiculously long and filled with multiple topics. I want to focus our discussion if that is ok with you.

 

I read your comments and would like to ask you simply:

 

Are you agreeing that the three detrimental forces of FUE (Torsion, Traction, Compression) exist in your opinion and are present during each of your FUE procedures?

 

Thank you.

Dr. Feller

Dr. Feller, I think dr. Bhatti already answered that question in his previous post. The forces are not detrimental in hands of qualified and experienced surgeons.

Lets be fair here, I saw many of your results, and I saw many of dr. Bhatti's results, and I do not see much difference in yield, coverage, etc.

Only difference is that you limit your procedures to <2,500 grafts per surgery, while dr. Bhatti does cases of >3,000 grafts regularly.

Cheers

Adonix,

 

I'm definitely not the only one making these comments here. Simply trying to clarify and urge all to do their research. I do find it odd, however, that you have 4 posts to your name and each one has been directed specifically at me. Interesting you mention marketing as well.

 

Mav,

 

Do your research thoroughly and you'll be good. However, just make sure you understand what is being charged and why. This site is the best place to do your research and chose a doctor. Period. AKA - no, our doctors are solid.

What can I say Blake, you post often, and you tend to (discretely) use the forum to market your and dr. Feller's business model (strip and mStrip).

It is amazing how you always manage to post small vague pieces information which are mostly negative towards FUE or like in the case above, negative towards non-NA clinics, etc.. No specifics, no proofs.

Some people pick on things like that, and I might be one of them.

If I am breaking any rules, let me know.

On other hand, I find your insight into finasteride side effects quite interesting and thanks for sharing it.

I'm not going to go into detail because it's just not a grenade worth unpinning, but I do have first hand knowledge that some clinics in areas of the world discussed earlier do not utilize proper sterilization techniques. These are standards accepted and taught in medical/surgical training in places like North America; I'm not completely certain what the accepted standards are in other regions, but I do know of some practices in areas that would not pass standards in NA.

 

Do your research and make sure you know precisely why clinics are charging what they are charging. Period.

Cmon Blake, either name those clinics, or stop playing the negative marketing game.

For your info, most of leading clinics in EU and Turkey have standards above most of clinics in the US.

Where did Dr L say the extractions were not more difficult? What was the yield of these subsequent procedures? How do we know there were not more attempts made to failed deliveries? How do we know how many grafts were wanted versus how many they were actually able to extract?

 

So, you're free to disagree, but this isn't evidence to the contrary.

The evidence part goes both ways. Instead of proving otherwise, you resort to asking open ended questions.

In any case, I responded to point out to holes in your theory on "mFUE" (in my opinion should be called "mFUSS").

My advice, rethink your approach to marketing. Its a thin line and could backfire very quickly. Your reputation could be ruined before you even had a chance to build it.

Adonix,

 

The subcutaneous scarring is simply physiology. I've explained it -- with diagrams -- many times. It happens, and one person saying it doesn't isn't proof. Until we have a decent "N," I think, as you stated, we should "avoid such claims."

My comment was not about scarring itself, but about subsequent extractions. No proofs whatsoever on that statement. If you look at dr. Lorenzos surgeries for example, you may find proof of fantastic yield in subsequent surgeries - more than a decent "N".

 

 

mFUE:

You seem to hit on a lot of the high points here. Strip-level results with FUE-level scarring.

 

 

This is not proven, and until we have a decent sample of successful cases, we should avoid such claims.

 

And you are right about traditional FUE causing a lot of fibrotic scarring throughout the donor area and this making subsequent extractions more difficult

 

 

This is not true. Dr. Vories already replied to you in another thread that in his experience there was no difficulty whatsoever in subsequent surgeries.