Dr. Alan Feller

I'm glad you now see and believe the forces exist. Now it's time to see if Dr. Bhatti now sees that as well. With respect to the video content, normally, I'd agree with you. But that video was submitted specifically for this debate. Surely he didn't post it such that only he could comment on it to my exclusion. What kind of debate would that be? Had it existed outside of this debate I would not have used it. If it had not been posted in this debate by its owner I would not have used it. But it was posted here to be viewed and commented upon, just as the other photos Dr. Bhatti posted on here. If Dr. Bhatti asked that it be taken down, what does that say about his belief in his position and his technique? As bill said, he needs to stand behind his video and perhaps he will do that.

How can we agree to disagree? The evidence is right in that video that Dr. Bhatti does not have grounds to disagree. What he said does not exist, exists. What he said I had no evidence of nor proof for is right there in full color. Again, how is this going "too far"? Dr. Bhatti posted this video in this debate unsolicited in an effort to counter my claims. The fact that it countered his own claims and supported mine is about as relevant and "in bounds" as you can get in any debate. Shouldn't it be HE who you are addressing now to explain himself? The issue isn't this particular patient, but the TECHNIQUE itself. Don't you see, HTsoon, that the traction force undeniably exists and therefore represents the very evidence and proof that Dr. Bhatti claims doesn't exist? For the forces to have been overcome, in this case, Dr. Bhatti would have had to employ either a novel technique or instrumentation. He did neither. What he is doing is hoping that the patient's physiology is very tolerant and tough and could endure the excessive trauma his FUE technique subjected it to. This is not "overcoming" this is gambling with someone else body. Maybe the patient will grow well, maybe he won't. But no matter which, he would have been in a better position had he had an FUT that did not subject the grafts to that completely unnecessary trauma. Isn't that obvious? The message I am trying to convey is that FUE causes more trauma to the graft compared to FUT, and therefore lower growth yields logically follow. Dr. Bhatti did not like that message and tried to discredit not just my observations, but me personally. He challenged me to a debate and I accepted. And here we are.

Yes he did. First he said they existed but that they were overcome. Then he changed it to they didn't exist and that I had offered no evidence or proof and that it was my unverifiable opinion. Well, that video is proof of traction force in the flesh if nothing else. Wouldn't you agree, Lileli?

But he did do that Lileli, in a post right after I put up my video. Does it really make a difference that he didn't bother to repost my video in his thread with his snide comment? I don't recall you defending me. If you did, I apologize but I couldn't find your post coming to my defense after he made that clearly disingenuous accusation. But I ask you, after viewing the video no matter what you think of me, is there or is there not proof and evidence of traction ?

I don't know who the "best" FUE doctors are, or who you consider them to be. While I most certainly came to my conclusion based on observation of results, this method is too subjective and could not be the basis of my position on FUE. Rather, I base it on the technique itself which is objective and free of personalities, ego, bias, money, reputation, and other subjective issues. By focusing on the technique itself, I know with certainty that the grafts are subjected to much more trauma when compared to an FUT. The common sense end result is a potentially lower growth yield. The rules are the same for FUT by the way. The more the graft is mishandled, the less potential for growth. This is hair transplant gospel. In this thread, however, Dr. Bhatti claimed rather loudly that the detrimental forces I described simply don't exit. He excoriated me for not having evidence of this nor proof. Is not the clip of his very own video the evidence and proof he claims does not exist at least with respect to traction force?

Now, what YOU just wrote WAS a low blow. Obviously I was using a motorized tool which vibrated. Not my hand. But Dr. Bhatti unprofessionally and disingenuously made that up and posted it. He made up a lie, I did not. Dr. Bhatti claimed that that I offered no evidence to support my claims. No proof. Well there is the proof. But apparently the truth holds no appeal or interest for you. You are partisan to the end.

What is so low blow about it? It's not out of context, it directly refutes the claims he made. And let's not forget, incredibly, he offered that video to contradict my claims. He put it into the debate unsolicited, not I. He needs to stand by it as Bill wrote.

Are you kidding?! This video strikes at the very heart of the debate. And you stoop to calling it slanderous and classless in an effort to discredit it? Where were you and your moral outrage when Swooping dug up posts of mine from 11 years ago and laughably posted them as a fallacious "gotcha". After you look up the word "slander," perhaps you should look up the word "hypocrisy". Facts are stubborn things, aren't they? This has nothing to do with opinion. Dr. Bhatti made a factual assertion that the grafts he pulls are not subject to traction forces during extraction-because, he says, they don't exist. His own video, without one word from me, is the most elegant proof one could offer refuting his implausible claim; little else could be classier or more persuasive. Remember, he offered his video as evidence in the debate he began for the explicit purpose of convincing me, and you, that his procedure was without any of the detrimental forces I claim obviously exist. Of course, that video says otherwise. Now that you have baselessly attacked the messenger, again, how about getting back to the message: Look at his video and ask yourself, is dr bhatti's claim that his FUE procedure does not contain traction forces true or false? Does this video indeed constitute proof of my assertions? Is it not a fact that there is a tremendous amount of traction observable? We await Dr. Bhatti's direct response. http://www.youtube.com/watch?v=BKfaYG5BRhs

I'm not sure what causes the more kinky appearance. It could be skeletonization or it could be the compression/traction. If could just be amateurs performing the surgery. I believe that when one "side" of the follicle is injured with respect to the other "side" the hair shaft that is produced can also be lopsided resulting in a kink. It may also be that distortion of the graft in the skin upon healing actually kinks the graft and thus the resulting hair grows out kinked as well. I do not comment on results of specific patients of specific doctors unless they present them during discussion/debate specifically to be critiqued by others like Dr. Bhatti has with his video. It is far better, more educational, and objective to discuss the actual techniques used, rather than subjectively look at photos of results. I have no idea why some doctors say what they say, newbie. When you figure it out, make a new post here. Thanks.

Dr. Bhatti, Why is it "unusual" that I would pick out the issue of you attacking me on this forum? Wasn't it you who wanted to look back into the history of negativity on this thread from your prior post? So I did and showed by page and post that you had in fact started the negativity with a personal attack. Until then I had never heard of you. I asked you in my response why of all people on the planet you assumed I would not take offense at you coming at me with both barrels blazing when you had no idea who I was nor had ever met me ? I'm still waiting for that specific answer and do not consider your last post an apology until you do. You also still owe Dr. Bloxham an apology, too. I don't care for your dismissiveness in your last post that "we are done here". If you wish to leave, then leave, but don't do so with false accusation that I haven't presented any facts to support my positions. Yes, we may be offering opinions, but mine at least are based on facts: I claimed that the detrimental FUE force of TRACTION exists. You claim that it does not and that I don't have any facts to back up my claim nor proof. Does the link to the video clip below qualify as proof of its existence ? Can anybody doubt the existence of this detrimental FUE force as seen in this video? http://www.youtube.com/watch?v=BKfaYG5BRhs https://youtu.be/BKfaYG5BRhs

As far as telling if someone had an HT there is a 90% chance I will be able to tell in person right off the bat. I play a game in my office sometimes in that I will walk through the waiting room looking at the waiting patients heads and try to guess if they had an HT, how long ago, and with whom. Certain clinics perform the same exact procedure on everyone so patients are often amazed that I could tell them where they had their last surgery and even when. As far as telling the difference between FUT and FUE, the FUE patients are almost always thinner for the number of grafts they report they received, and their hairline are almost always very sparse compared to the FUT counterpart. There is also very often an increased "kinkiness" to the hair. This also happens in FUT, but not as much in my opinion. But, let's say the FUE yield was on the high side, then it could be indistinguishable. I want to reiterate that I think FUE is a great procedure, I am just not a fan of FUE megasessions at least until the donor area has been "stripped out". After that everything is gravy as long as enough donor area is left to conceal the scars (FUT and FUE).

Thank you, Tommy. That was very nice of you. I appreciate the kudos.

So let's get this on the record so it can be quoted 9 to 11 years from now: 1. FUT yields are better than FUE yields and this disparity increases in direct proportion to the increase in FUE case size. 2. I've seen far more FUE failures than I have FUT failures. 3. I have rarely seen an FUE hairline that compares to an FUT hairline in fullness or naturalness. 4. I have yet to see a properly performed FUT injure the donor area as much as an equivalent FUE. 5. No matter how well or poorly an FUE case grows, the equivalent FUT would have grown better.

No. I don't think there is much selection going on at all out there. Certainly not like it used to be before FUE megasessions. Now it's just grab as many FUE grafts as you can and throw them at the recipient area and hope they grow.

That's all it takes for you to declare a "nail in the coffin" gotcha? Really? Could I have seen more FUT failures as opposed to FUE failures back in 2002 because FUE had literally only been introduced into North America less than a year before? You couldn't figure that one out for yourself ?

No change in opinion. I may have been a bit generous with my statement of FUE yields at the time, but that was because smaller cases were being done and doctors were being more careful with their extractions and whom they selected to do FUE on. You do know you are quoting me from 9 and 11 years ago. Right? That was a very different time for FUE. FUE Yields back then were almost identical to strip because back then your average case was only 500 grafts or less and were used primarily for fill in and repair work, not as a primary HT means and not much stand alone hairline work. The practitioner could take his time to perform the procedure as delicately as possible to minimize stress on the graft. Speed was willingly and necessarily traded for delicacy. It wasn't until some clinics started speeding up the FUE process to perform larger cases in one day, or to even perform two cases in one day, that problems started being reported. In these clinics, delicacy was traded for speed. Healthy for the bottom line, but not so much for the grafts. To me, this is an unacceptable trade off. In fact, the very first four major FUE megasession clinics were banned from this very forum. If you read point 2 in my post you will see that I wrote that session size should be limited to no more than 600 grafts on the average patient and 1000 grafts on the great patient. 1000 FUE grafts was considered a lot in those days. I even wrote why: because of fatigue and graft "yanking". Until clinics started speeding up, every doctor gently grasped their grafts and applied traction until the tissue released at its own pace as I demonstrated in my video 2002. To speed this up, the doctor would have to "yank" the grafts out quickly and with greater force as Dr. Bhatti demonstrated in his video of 2015. I have not changed my mind since that time The smaller the session the better the yield. The larger the session the worse the yields. When I wrote that yield is the same between strip and FUE in 2006 it was under VERY different circumstances than that for which FUE exists in today. Far fewer patients qualified as candidates and much more time was used to remove the grafts. But since then, I have learned that in many patients no matter how careful the practitioner is, the final growth yields tend to be lower than it's strip counterpart, particularly with respect to FUE hairline success. I also started to notice since 2006 how badly fibrosed the donor areas were getting for patients with multiple FUE procedures. My patients included. I came to realize that each FUE case was making it more difficult to extract for the next FUE case. But when I realized the ability to potentially grab a strip with any useful grafts in it was being compromised because of fibrosis and disfigurement I really backed off. And here we are today. That's why I don't even care for multiple small sessions of FUE to get to megasession numbers.

What am I missing here? I was 100 % correct. Can you please point out specifically where you "got me" ? Thank you

That's actually pretty funny

I don't wish to discredit FUE. I wish to make it more transparent and understandable to patients. Unlike FUT, this procedure started in secrecy. And to a great extent it is still veiled in secrecy. I'm just throwing a little light on it. I'm sorry if this offends you but it's not intended that way.

Thanks for the critique. How would you change the design? Do I do the same on every patient? What would make me an "A" in your opinion? FUE is in my signature because I offer it. But I know what you mean. I am not against FUE. I I've been intrigued by it since it was first introduced. But from a technical standpoint it has limitations and a point of diminishing returns. The larger the case, the more the diminishing returns. As I did larger and larger cases years ago, I began to see not only the decreasing yields, but the increasing fibrosis throughout the donor area. Then as I began to see the patients of other doctors doing larger FUE cases I knew the current methods of FUE were inadequate. Until someone comes up with a revolutionary way of doing FUE, it should be limited to smaller cases. Your thoughts?

Unfortunately, I'm afraid we are going to have to agree to disagree. Thank you for saying my video's are entertaining, though. At least I don't "suck" at everything.

At first I used it to keep my recipient site slit making in straight lines when I switched from sagital to coronal slits. After a while I didn't need it anymore but realized that the extra reference points came in handy when working. When I make recipient sites I wear magnifiers and you can actually get "lost" when your in the recipient area, so the grid lines help orient me. Also, it comes in handy for visual reference when you want to create density differences through the recipient area. Today I did two procedures. The second patient I made uniform density throughout the "2-3 FU" area. But the first patient I varied the density of the "2-3 FUs" to account for his native forelock hair. The grid lines made it very easy for me to remember where to change density.

I did not know that. I agree with him and his reasoning. Thank you for the info, Pup.

Yes you did. Congratulations ! Play again.