Dr. Alan Feller

Good stuff. Didn't know both procedures were performed by you. Almost looks like two different Dr's because the approach is different. Thank you for sharing.

Interesting, isn't it?! I think there are a lot of differences between FUE and FUT that just aren't discussed.

Thanks for playing.

I was right then. A good demonstration showing how graft tissue plays a major impact in growth. Good work sir! I love these games!

Congratulations, Yaz!

I'm glad you like playing. More games and challenges coming on this and other threads.

Sorry, Mav.

Play again !

FUT on the left

FUE on the right

Because the grafts from the FUE were thin from skeletonization I had to make smaller recipient slits. I also packed it closer together to make up for expected drop in yield, which did happen.

Because the grafts from the FUT were nice and chubby, I just made the slits normal distance from each other as I usually do. Normal growth yield.

Infected FUE extraction sites?

They are definitely irritation, but not infected sites. Infection is very red or "hot". This stuff isn't. It is just normal staple holes immediately after removal. An infected FUE site would be huge compared to this. Several of them in a row could be seen across the room.

But where is the original strip incision ? We couldn't find it.

Very fine line?

We thought the same exact thing Matt. We were pretty satisfied with ourselves until I noticed it was just the top of the staple site fibrosis that ran together. Turns out that's confluence of staple scar, not the incision scar. We couldn't find it in person either.

I'm going to keep searching the photo until I find it though, it must be there somewhere.

We thought this was a really unique case so we decided to share.

staple hole

If it's a staple hole. Where is the incision site?

Hmmm seens like an transection root? Maybe the graft was mishandled when extracting?

Didn't think of that, Yaz. But, nope !

Here is a close up of something.

What do you think it is ?

And the answer is ????

And the answer is...

Well, wait a minute. Let me tease you all for a moment before I accept your final answers. Does this help? Same guys same sides:

I called this thread baseless because it is your opinion only and you have no proof to support your position. Was my tone slightly harsh? For me, yes, but I find it difficult to believe you were genuinely offended. If you were then you have my apology but I feel it necessary that you should apologize to my patient. I require no such acknowledgement.

Dr. Bhatti,

Respectfully, EVERYTHING written on these chat sites are informal opinion. Each post is not a medical journal submission.

But I did find your opening statement offensive. You didn't just say my writings were baseless, you wrote they were "baseless RANTINGS". A clear pejorative and personal attack against me, not just a critical reference to the substance of the writing itself.

Why would you assume that I, or anyone else, wouldn't be genuinely offended ? You don't know me. What specifically made you think you could act so rudely on a public forum to a physician you've never met or talked to before. I honestly would like to know. Clearly it was something.

I agree, the negativity has gone too far and I’m sure the posting history will show where the negativity is coming from.

 

I will remind everyone that the video was not removed. The video remains on Youtube, untouched, and in five postings by Dr. Feller.

 

Mr. Bill, you said the following,

 

“I've already acknowledged that I haven't followed the debate closely over the last week or so. If discussion of the video is dead, that's fine. But I wanted to make it clear that I never advocated for the removal or editing of the original video. I am a firm believer that apart from minor revisions for spelling or grammar, members should stand behind their posts and do minimal editing."

 

I did not suggest Mr. Bill that you advocate my actions. I stated earlier that you gave me permission. Do I misunderstand the word? I know the word “permission” to mean being allowed something. Does the word “permission” mean endorse or support? Indeed, you advised me and I chose to do what I thought would be acceptable. Dr. Feller has the original video posted five times so I did not believe it to be an issue and I do not understand why it is so controversial if the original is intact here and on my You Tube channel. I agree posts should remain with minor revisions for spelling or grammar and should not be removed but recent history suggests otherwise. My post was untouched but the video was edited over seventy pages ago and a private email exchange, that supports my original position still and shared without my permission, and I am being attacked for changing something that still exists in it’s original form with five copies and over 450 views. Dr. Feller even claimed that the embedding feature had been disabled when it clearly has not. Yet when another physician wishes to have his entire post removed it is done so without incident.

 

Mr. Mav23100gunther,

 

I believe this email trail, which was posted without my authorization, shows what I said from the beginning. I wished to concentrate on the extraction and I believe the circle of focus helps to do this. If you watch the edited version you will also see that from the 2:00 point to the 2:29 point there is no circle focus effect. You can also see that I have each sequence labeled for clarity and I have also included information about the forceps. They are the CIT forceps, which prevent crushing contrary to Dr. Feller’s claims. I’ve said this before.

 

I am of the belief that this obsession with the video is another effort to detract from the lack of evidence to support Dr. Feller’s claims. He says the detriment nature of the three forces he lists are fact but the only fact is that they are his theory. He has no proof that these forces are so detrimental that they cannot be overcome, which is required in science and medicine before a challenge to refute can be made. I also believe this is a ruse to reduce the credibility of FUE in support of his new procedure which supposedly solves problems that none of you knew existed.

 

I have some questions that I would like asked.

 

1. What is the size of the punch for mFUE?

2. How long has mFUE been in development?

3. Did Dr. Blake work on the development of mFUE while he was under your tutelage?

4. Did Dr. Blake know he would have a financial benefit from the development of mFUE or anything related to your practice?

 

Mr. Mavgunther21300, I believe you asked earlier why mFUE was of any concern regarding this thread. I had elected to not continue with this line of thinking as I felt the thread was finally retiring but since it is now revived I will tell you why I was discussing this. I believe it was compulsory for the professional relationship between Dr. Feller and Dr. Blake to be revealed to the community from the beginning, which according to Dr. Blake was two years ago. Dr. Feller is a competitor, not necessarily to me, but to many doctors in North America and particularly in New York and many of them are paying members of this website. For there to be a moderator of a forum that influences the surgical decision of many many people with his “opinion” while simultaneously being influenced by a a paying member that is a competitor, with financial gain either directly or assumed from the relationship, is a conflict of interest.

 

Harvard Medical School states…

 

"Research that involves human study participants or samples is subjected to higher scrutiny with respect to the potential for financial conflicts of interest. This is because the ramifications of bias in clinical research are more immediate and directly impact the safety and welfare of clinical research participants. This rule guards against bias, or the appearance of bias, that might occur if a faculty member conducted clinical research in which she or he had a financial stake in the outcome or allegiance to the funding company. Such a conflict might cause the faculty member to alter his or her study design, conduct, or reporting of the research in some way, whether consciously or unconsciously, or it may cause the public to lose trust in the reliability of the research outcomes. "

 

In a case such as Feller/Bloxham the “study participants” are you, the forum members. The “funding company” is Dr. Feller and the “faculty” is Dr. Blake.

 

In some cases some financial associations are acceptable but in every case the relationship must be disclosed, much like how representative on the forums must disclose their relationship with the clinic they work for, which was what Dr. Feller was accusing my patient Sethicles of being. In short, Dr. Blake was working/training with Dr. Feller and developing a new technique for two years with the intent of profit once training was completed and a partnership was formed. It is my opinion, based on statements and timelines shared that this is the entire reason for Dr. Blakes admitted transition from believing in FUE to being a naysayer. It is also the reason for the re-emergence of Dr. Feller after a year and a half and these threads designed to discredit FUE and deliver mFUE as the solution to the problem that cannot be proven to exist outside of Dr. Feller’s hands.

 

 

Good day.

Dr. Bhatti, You agree the negativity has gone too far, then in the same line throw fuel on the fire and attack me for having started the negativity.

So yes, let's go back to where all the negativity started: (Page 37, Post #366):

You titled your post: Dr Feller's baseless rantings !

That sure seems like negativity to me, especially since until that point I had never heard of you. I mean really, who says such a thing about a doctor he's never met? So who actually started the negativity, Dr. Bhatti ? And Mav23100gunther, respectfully, are these the words of a gentleman?

Dr. Bhatti, it's true you didn't remove the original video, but I believe it's because you knew if you had you would have been caught instantly. You may claim otherwise, but your posted reasons are not very believable.

And there is, of course, no valid reason to go back into an old post to remove the "incriminating" video and replace it for a more toned down version that clearly contradicted your views on this thread and supported mine. You could have simply ADDED the new video to the old post and nobody would have cared. Least of all I. But you didn't do that, you engaged in what could only be seen as a subterfuge that you were warned about by the moderator even before you did it.

You clearly will not stand by your technique as demonstrated in the video. You have spent pages and pages trying to get away from it and only scream and holler that I haven't provided "scientific evidence". Your original video IS the evidence. It's CLINICAL evidence and that's VERY scientific. In fact it's better because that's what's happening in real life and anyone can see what's going on. Nobody can look at that technique and not come to the conclusion that it is rushed, very indelicate, and more traumatic to the grafts than FUT. Even you haven't come out and said flat out " oh, there's nothing wrong with this technique. It's perfectly fine to rip the grafts out with a single forcep and rake them around on the head willy nilly." To outright say this would be contradict 25 years of hair transplant gospel -which states above all that GRAFT HANDLING is the most important aspect of ANY hair transplant surgery.

Your video is the single most important piece of evidence supporting my position that FUE is brutal on the grafts compared to FUT. You made a mistake posting it. Then you made a mistake in trying to blurr out the most egregious parts. Then you made a mistake trying to quietly slip the new version into your old post. Then you made a mistake trying to use your interaction with Bill as some sort of approval for your activities.

You made some poor judgments and choices. This isn't a court room. You're not going to get into "trouble" for it. Just accept your errors and move on. I get no enjoyment out of this exchange and don't feel I'm winning "points". My goal was never to have to get into a protracted personal battle with you, my goal was, and has ever been, to debate the aspects of the FUE technique. Doesn't matter who performs it. So I never focused in on you. As I wrote, I never heard of you prior to your first post.

Your technique as demonstrated in your original video is representative of FUE techniques in general and does not compare well to the delicacy of an equivalent FUT case. But even in the FUE world I think it is fair to say your technique appears rushed and more traumatic to the grafts and tissue compared to more paced and deliberate FUE techniques demonstrated by others. Certainly the two forceps approach would be superior. Don't you agree?

I think this thread has become one of the most transparent and educational threads on the topic of FUE from the objective "surgical" point of view, instead of the cherry picked subjective "results" point of view. Of course practitioners are only going to put up their best results. That's expected. And most patients who are unhappy are reticent to post their results so the bias is insurmountable.

That's why my focus on the three detrimental forces is so important. Because it subtracts out all the subjectivity, egos, and personalities. It demonstrates the success of the surgery from the graft's point of view. Everything else simply follows from that.

I will continue to espouse my position and opinion of FUE techniques like yours and continue to contrast it with the far more gentle and far more proven FUT technique. I'm truly sorry if this offends you or even if you find it threatening but the truth is the truth and someone has to deliver it for patients to be fully informed. For them to be LEGALLY informed they need to have this information available, and I have seen NONE of it online with the exception of this thread.

As long as you post your videos in good faith as a demonstration of an FUE technique, I will in good faith continue to use the information in those videos to support my points as they apply. I would invite you to counter my points if you can. If you refuse to, that's one thing. But if you can't then, respectfully, perhaps you should think about modifying your technique instead of the video you use to demonstrate it.

As for your other accusations they are absurd and demonstrably false. I'm used to being attacked by anonymous posters and know what I'm getting into when I post a thread online. But what you wrote as a physician in a public forum about Blake was extremely inappropriate and I for one think you owe him an apology.

Hi Bill,

 

I believe that Dr. Bhatti has explained in detail several times already why he felt the need to edit the original video. Please note that the original video is about 15 minutes long, and hence way too long for sharing on this Forum. There was no attempt to "change" or "hide" anything. Dr. Feller repeatedly re-posted Dr. Bhatti's video (at least 5 times, if not more). Had we been trying to "hide" anything, we could have easily taken down (or edited) our youtube video. We did NOT.

 

I am surprised by the different benchmarks and protocols that are being applied. Very recently, an esteemed HT Surgeon, Dr. James Harris posted his views about the FUT vs FUE debate on this thread. Everyone that read the post from Dr. Harris would agree that it was mainly pro-FUE and was refuting Dr. Feller's claims. A little while later, Dr. Harris deleted his post. Everyone (including most of the HRN members, David and yourself) agreed that we should respect Dr. Harris's wishes about deleting his original post. I also endorse that opinion. Now, flip over to the Dr. Bhatti video edit "issue" and see how big of a mountain has been "attempted" to be created out of a molehill!!! Does Dr. Bhatti not have the right refine what is his property (video)? Again, had there been any intention of concealment, the original video would not have been available anymore.....The fact that it is readily available for anyone to see (with multiple links from Dr. Feller on this thread alone) proves that the edit was done in good faith. The original video was a "rough cut" and the edit was done to make it more concise, shorter, to the point and refined. Nothing more, nothing less.

 

Best regards,

California

How was the edit done in good faith? You specifically blocked out all the parts that had supported my claims and refuted Dr. Bhatti's claims. Then you waited eight days for the thread to advance pages away from the original post and quietly went in and changed it even though Bill told you not to do it. By doing that you invalidated any subsequent post thereafter that referenced that original post and video. Basically put, you changed the past on the sly to hide the contents of the original video. But you got caught. You didn't think you would because who would check 40 pages back? But I did by shear luck.

Of course you couldn't take down the original video yet, you would have been instantly caught. You didn't leave it up in good faith. You left it up because you had to. I have no doubt you would have broken that link as this thread faded away leaving just the new version.

If you really produced the new video in good faith and wanted to post it in good faith you would have done so in a new post or a new thread and announced it loudly. You didn't. Instead you snuck it into an old post and falsely claimed that Bill approved of this maneuver. I knew he wouldn't and his email attests to that. Simple, Dr. Bhatti tried to cover up the video and got caught, then he lied about it and got caught again.

I think I've had just about enough of this negativity. I think everyone has. If you felt compelled to engage in this kind of obvious subterfuge then I suspect you're sick of it too. I've made my points. I am satisfied. Go and do your thing. I'll do my thing. But if I wish to express my opinions, observations, and experiences about FUE or anything else I will thank you not to harass me or try to silence me. I am entitled to my free expression on this site without harassment from you. Stay away from my threads and I, as always, will stay away from yours.

Left FUE, Right FUT.

 

Headband seems lower on the left so I will guess he had to go with a higher hairline to compensate for fewer lifetime grafts?

Another unique piece of reasoning. You guys are really making this thread a pleasure !

Ok Matt, your answer is noted. We shall see tomorrow night.

Thanks for playing "Which is Which"

even if I'm not stripped out yet and already have the linier scar?

Yes. When I started doing mFUE it was exactly in patients like you. The kind where another strip wasn't possible and the FUE yield was awful due to fibrosis. But I really am not here to market that. We will roll that out as more of our patients come back and show their results. Did you see Dr. Lindsey's presentation in the old FUT vs FUE vs mFUE thread ? Very eye opening.

Until tomorrow night. I'm calling it a night. So good night.

Dr. Feller

I haven't really researched FUT because I don't consider it an option for me. I am sure FUE yields are a bit lower, but not by enough for me to stress about it.

 

I already stated what I think your angle is (disparaging FUE; possibly suggesting that the right patient had his grafts more densely packed to compensate for lower yield), but I could be wrong. And yeah I'll stick with my initial prediction.

Don't sell yourself short. You may well be right about Which is Which.

But my angle really isn't to disparage FUE. That's a wrong impression of me. My angle is to be successful and to produce as many great results as possible given what I have to work with. Happy patients mean more patients tomorrow. Dissatisfied patients mean fewer patients tomorrow. That's my simple philosophy.

Ok, you're answer is noted. I shall reveal all tomorrow night.

My final answer is still that the right side is FUT as its appears to be a larger coverage area. For the FUE procedure, it's a smaller coverage area, but you had to use the same number of grafts to compensate for lower growth on FUE. For the FUT procedure you were more comfortable using the same number of grafts over a larger area.

You'll just have to wait until tomorrow night to find out. Tonight you can dream about a free mFUE. Think about it: the yields of a strip but no linear scar. OOPS, there's that sly marketing campaign again !

Dammit, I thought I had it there. Does the winner get a free FUT procedure from your clinic? You know I had to ask

Perhaps an mFUE

I've got it - the right picture is FUT as there appears to be more coverage and what looks like more grafts implanted. Even though the same number of grafts were extracted, some from the FUE procedure got damaged and were never transplanted?

Again, I amazed by the thought process. I hope you're having fun with this because I truly am. I get your reasoning and it's excellent, but in my clinic I do not count and bill for the number of grafts extracted or attempted, I only count the grafts that were extracted intact and passed individual inspection by one of my techs and is actually implanted.

So in each photo you are truly seeing the same number of grafts in each. But you are getting warmer.

confusing information coming out of the F&B clinic, one says no the other says yes.

 

Id say the right is FUE, only because of the red skin, which looks the same as what my skin looked after my HT the left seems lighter red,

 

is the redness a bad thing or a good thing

As far as I know Dr. Bloxham and I are in agreement on our FUE hairline view. But I'm sure he'll chime in somewhere to clarify his position. But I don't want to get away from the "which is which" game.

You are now the third person to refer to the redness or bloodiness to assess the situation. So fascinating. Do you know I don't think any HT doctor would even notice the difference between the two in these terms?

As Mav noted, I am learning a lot about how the average poster perceives post operative photos.

The redness means nothing. It's neither bad nor good, so not to worry.

So let's say your answer is the right one is FUE. I'm not going to say the answer yet, but I'm going to say I like the reason you used to pick the photo to the right and I will touch on it when I give the answer.

Now let's let a few more people give their answers and reasons then I'll reveal the actual answer tomorrow night. And assuming Dr. Bloxham and I have time after surgeries tomorrow we will make a video that includes both cases grown out and the details of each surgery.

Thanks for playing.

Welcome into the mind of your average Joe! Yes doctor, based on the information that has been presented to me, at this point in time I am going to trust that FUE grafts are more prone to damage until such time as this can be proven otherwise. I'm not going to opine on this, but I take no chances and FUT is tried and tested. I am not discounting that this could be an incorrect assumption in the hands of a Lorenzo or Erdogan, but all the evidence is pointing me to the fact that an FUT by the likes of Dr Ron Shapiro, Dr Hasson, Dr Rahal will be safer than any FUE.

Fair enough.

Are you sticking with your answer as far as which is which ?

Hahaha. Come on doc. The jig is up. Anyway, I haven't seen evidence of it. But that doesn't mean it isn't possible.

Are you saying you may have a small doubt and that FUE yields may not generally be on par with FUT yields ?

What jig are you referring to ? You can be honest, I promise to not be offended. What do you think I"m concealing; or, what angle do you think I"m playing ?

Speaking of playing, are you sticking to your answer that the right one is the FUE ?

so if your clinic is saying there are up 7 detrimental reason why not to do FUE into hairlines then why are you doing them, surely that means there isn't 7 detrimental reasons

I"m not sure what the 7 detrimental reasons are. I usually only mention the top three.

Regardless, I will perform an FUE on a patient, even in the hairline, if and only if they listen intently to the differences between the performance of the two procedures, their expected yield differences, and the amount of donor scarring expected. Then they have to sign an Informed Consent form that says flat out that they were informed of FUT and rejected it. Then and only then will I perform an FUE. And, of course, I have to believe it will make a cosmetically significant difference or only strip or mFUE will be offered.

I don't begrudge clinics performing FUE to any extent, as long as it is appropriate based on the knowable physiology AND they have give proper Informed Consent which actively includes a clause stating they reject FUT in no uncertain terms.

Make sense?

Give it another shot Seth. Which is which ? And which do you think grew better in the end ?

Suspense is killing me doc, I have no idea which is which. It probably has something to with the bleeding, but I have no idea why. . For my first FUT procedure, I bled a lot, so looked like a zombie afterwards. My best guess would be that the bloodied one is FUT as there is more protective tissue surrounding the grafts which means the incisions had to be larger resulting in more blood, or the flip side and the more bloodied one is the FUE as damaged grafts had to be forced in?

Wow! I am truly fascinated by these answers and thinking processes. It seems you and Lileli think along the same lines. And if you two think a certain way, then probably a great percentage of the population thinks that way, too. So interesting. Can I tell you that I didn't even notice the difference in the amount of blood between the two. By the way, both photos shot at the same exact amount of time after surgery.

I'm not going to give the answer yet, but I will say that the amount of blood will give absolutely no indication of the answer.

Do you believe that FUE grafts are more prone to damage than FUT grafts ?

Non-NA doctors don't seem to necessarily favour either method. They just react to demand. They don't, from what I can tell, attempt to hard-sell any particular method on their patients. Feriduni, Bisanga, etc. will do FUT or FUE for the same job. I'd be curious whether they quote more grafts if you opt for FUE though.

I never thought of that. Do YOU think yields for FUE may be lower than FUT to the point that these doctors feel the need to compensate by offering more grafts for the FUE choice ?