Dr. Alan Feller

Sorry Seth, you goofed again on the facts as usual. Perhaps you should ask me about things you don't know about or understand before you come onto a public forum calling me a liar. That video was POSTED to Youtube in 2009. But it was FILMED 6 years before in February of 2003 at the very dawn of FUE. What you saw was my prediction for FUE and I was 100% correct. I also said several times it would be an ADJUNCT to FUT. So where is the "gotcha" value? I never said FUE would replace FUT, or that all doctors should get onboard the FUE train, nor did I do back flips with my own words. Here's the link to the video again and the viewers can determine who is a liar and who can be trusted: And what does this have to do with the popularity of FUT over FUE. And what does this have to do with the three detrimental forces of FUE ?

I'm sorry you're dealing with shock loss. Most of what you will read will refer to regrowth of shock loss in the recipient area within 3-4 months. That is, it will begin to recover in that time. But no two physiologies are exactly alike. Neither is the amount of damage the skin can tolerate. Are the hairs in the area that you now believe is shocked normal healthy hairs? Or were they on their way out? If this is the case, the surgery may have just sped up the hair loss process. But that is NOT shock loss. Any photos?

Excellent post ! I want to mention that internet forum chat sites are ugly places. There are no exceptions. Just look at the very first post made by a viewer after my initial post that kicked off this thread. Nasty, isn't it? It's nothing but intimidation by someone who didn't agree with what I had to say. He couldn't discredit the words, so he went after me and my business personally. I have found being blunt, direct, and intolerant of evasive behavior keeps threads on track and reduces attempts by those who would try to intimidate me or hijack the thread. That's why this thread is such a success and has lasted so long. If I tried to be agreeable to everybody this would have turned into a milquetoast thread and died within a few days and a hundred views instead of over 50,000 as it stands today. Your observations are very good. Keep them coming. Thank you. Dr. Feller

Correct me if I'm wrong here. But wasn't it you and your doctor who falsely accused me of writing something I didn't? And when I challenged you to post my "offending" post you couldn't do it? But you continued to post as if I had until the moderator had to post the truth and stop you. Have you apologized for this yet? Nope. I have insulted nobody. I have been attacked by you, your doctor, and many others and I have defended myself. Interesting how you cry for Mickey (even though he never asked you to) but when I'm attacked viciously by multiple people not a peep from you. Such a humanitarian and such false righteous indignation.

Correct. But of course he knows that Mav.. He's hoping YOU won't notice. Anything to distract from that video of his.

I get it. Believe me, I'm an HT patient, too. The thought of a strip surgery is REALLY what's driving the desire for FUE. Very few people are really concerned about hair style options afterward. And if FUE grew as well as FUT I'd be doing them. But it doesn't, so I don't. So many patients who come to me for strip are anxious about the idea of it. You should see some of them in the morning of the procedure. Anxious and excited. But I tell them what's happening as we go along step by step and EVERYONE gets though it and says the same thing: "that's all it was? I didn't feel anything. Wasn't at all what I thought it would be." It would no doubt be the same for you. When the time comes you'll know when to pull the trigger.

They don't have to comment. FUT is the gold standard and hasn't been "on trial" for the past 14 years. FUE has and is. Try and make the same thread for FUT and see how far it gets. Think Lead Balloon. The other reason is basically posters like yourself who attack doctors when they post an opinion different from yours. It's not worth it to them. The real question is where are all the FUE doctors to refute my claims? Your doctor got roped in by a stupid mistake he and his rep made. At least Dr. Vories showed up to his credit. But he smartly avoided the real controversy details and backed away. What you don't get, Seth, is there is no debate here. I KNOW the problems of FUE because i've been doing them for 14 years. I'm just very honest and open about it's shortcomings. FUT also has it's shortcomings, and I've written about them for years. But FUT has less than 5% of the shortcomings of FUE and is why it's still king and will remain king until those three detrimental forces of FUE are reduced or eliminated. That is the reality, the rest is just fluff.

You bring up a good point. No surgery is easy to watch. But try to tune out the repulsiveness of the surgery itself to focus on the trauma inflicted on the individual grafts. Now compare that to a linear strip being divided under 8 microscopes at the same time by 8 experienced technicians. No contest, and that's the part of the video I want people to focus on. Other than that, even a video of getting a mole removed is repulsive. I don't hold that against any practitioner, but I do hold what is clearly rough and rushed handling of tissue against them.

Unilateral? Nice try, but not so much. After 50,000 views, over 1,000 replies, and one incredibly frightening video by your doctor demonstrating EXACTLY what I'm talking about, I'd say controversial is a fair word to describe FUE.

This is a great idea. The more honest, open, and clear the consent form is about the risks the more we know about how transparent the doctor is. In the United States informed consent is a legal requirement, but not so in other parts of the world. Particularly the third world where megasession FUE clinics have grown like weeds. That's telling.

50,000 views and over 1,000 replies. Another milestone. I think at this point it is fair to say at best FUE is still controversial and FUT retains it's title as king of Hair transplantation

That is not his challenge. His "challenge" is to compare the shear number of patients who have had FUT and seek his "repair" services to the shear number of patients who have had FUE and seek my "repair" services. As I already wrote: 1. There are thousands of FUT patients for every one FUE patient so it is absurd by the numbers. To not understand this is to either be disingenuous or suffering from a severe learning disability. 2. I nor anybody else offers to repair moth eaten FUE donor areas or failed growth in recipient areas. He's asking for me to present patients who visit me for a repair procedure that isn't performed and one that I don't offer. 3. He conflates people visiting him for FUE services who have simply had FUT in the past with patients seeing REPAIR from him. In reality, these patients just want more grafts in their recipient area. 4. None of the patients he showed with the Tribune slapped in front of it demonstrated a recipient area "repair" or a donor area "repair". He didn't fill a single scar with FUE, although in two of his photos the patients could have benefited from such FUE repair-which is one thing I believe large FUE is designed for. As far as bad FUE scarring from megasession FUE being a rare occurrence, I can assure you the opposite is true. ALL patients with megasession FUE have massive scar tissue. If the patient was selected properly and had enough donor density then the scarring can be hidden with some hair. But if the patient wasn't filtered properly, as most are not, you are left with a destroyed donor area and very thin hair left, if any , to cover it.

Mav, We can't go to the September ISHRS meeting because we have the entire week booked with patients most of whom booked almost a year ago. As far as presenting mFUE, while Dr. Bloxham made a presentation with some very broad strokes online, there are some aspects that we still can't discuss yet as it will interfere with the patent process. Dr. Feller

Bill, You are missing what he is writing and claiming. I have made no claims other than those that I posed to Dr. Bhatti who refused to answer them about 50 pages back. Once again I have to break down Dr. Bhatti's distortions, evasions, and disingenuousness. Dr. Bhatti's "challenge" is not a "challenge" It's a straw dummy. He might as well challenge me to compare how many Indian people walk past his door in India as I have Indian people pass my door in Great Neck, NY. It's nonsensical. I'll explain: 99% of the HT patients in the world have had their surgery via FUT, so obviously if a patient is going to walk into his or my office the chances are astronomically higher that it's going to be an FUT patient. So how does posting that online on a daily basis with the day's copy of the "Tribune" mean anything other than the fact that there are more FUT patients in the world compared to FUE? It's disingenuous and he knows it. I also don't claim to fix the scarring left by FUE. Nobody does. Nobody seeks me out to repair their moth eaten donor areas because I don't offer it. These people are unfixable. He knows this, but is challenging me to produce patients who've come to me for such repairs. He, on the other hand claims to be "repairing" FUT patients in those so-called "challenge" photos he has posted and is implying he has sooooo many patients coming to him for this. Problem is, not one of the patients he showed after his "repair surgery" had their linear scars addressed! He may have added hair to recipient areas via FUE, but that is not "repair" work as he claims. So the photos have no validity or connection to what he's claiming when he posts them. So what's the point of showing shaved down donor areas to reveal linear scars? His after photos only show recently punched out grafts via FUE. So what? Am I to show recently stitched FUT incisions? What purpose does that serve? None. In another version of his challenge, because as usual he changes reality as he moves along, he wanted to compare the scars from my FUE megasessions to his on a daily basis. But he knows I don't do FUE megasessions for the reasons I've stated only about 100 times on this thread. He knows this. So how exactly is that a "challenge"? So what he's really doing is showing photos of the eeeevil strip scars, the more hideous the better, to scare the public and try to come across as the patient's savior. But his after photos do not show a "saved" paitent. They do not show a "repaired" recipient area nor repaired donor scar. They just show an immediate post op donor area with a copy of the Tribune for some reason slapped in front of it. So what? His only goal is to show horrible strip scars with no information as to why those scars may be as bad as they are. So it just becomes a war of who can put up more horrible scar pictures. Well that's easy. If you want me to indulge him I will. Here are some hideous FUE scars:

Nick, If I agree with any particular FUE technique, it's the one you describe your doctor does. Meticulous, cautions, and paced. Might be 800 in an entire day, might be 1500. And that's how it is. The patient's skin dictates the time and number of extractions in the day, not the practitioner, correct? Forcing it and rushing it cause trauma, damage, and transection, correct?

I don't believe the yield difference between FUE and FUT is slight, even in the hands of the best FUE practitioners. And who are the best FUE doctors? We need a definition for this. And in your opinion, how many top FUE doctors are there to your knowledge? What makes them top notch? And please don't say before/after photos. Every clinic puts out beautiful before/after photos. The more patients they do, the more impressive photos they will have just through numbers. So that method is far too subjective. When I read through surgical journals you don't see a list of results. Rather, you see detailed photos, description, and analysis of the method used to achieve the results. The commentary and debate thereafter is based solely on the technique. What other criteria do you think could be used that would be more objective?

Yeah, I ran into the same problems. Bill says they are working on the problems. All good. Thanks.

"Had you come on here and said there are a handful of surgeons producing high level results via fue similar to the best strip surgeries but generally strip yields better results then I would agree! Strip is more consistent with yield,but fue in right hands CAN and DOES match strip in the right hands of a proven experienced Dr! !" I will agree with this with three wrinkles. The first is that the patient must be of a very select type. So the doctor has to be honorable and not accept everyone who walks through his door. And the second is that for this patient to achieve the same look as the equivalent FUT patient more grafts will most likely have to be used due to the injury factor. And the third is that in the FUE patient more donor area has to be scarred to obtain the grafts necessary to produce FUT level results. The quality of the surgeon will always make a difference. I think we can all agree on that. The most dismal FUE results are coming out of the offices of amateur doctors who really aren't performing HT full time or are start ups. I've met MANY of these doctors and they don't know what they don't know yet. Frightening. Same for FUT by the way. Can we say, based on these terms, that we have reached an accord?

I wouldn't be surprised at all if after your discussion he removes the sensational scare tactic pages from his site. It's beneath him. I just clicked the link you included in your post and am shocked by that quote you put up. I couldn't believe it was accurately quoted. But it is. I am genuinely shocked by these claims. Do you believe these claims to be true? Does anybody reading this thread?

I cannot and will not comment on individual doctors and their patients. And you shouldn't either. Who is going to be more willing to post results and keep posting results: happy patients or unhappy patients? Trust me, it's happy patients by a wide margin. But the unhappy patient numbers are rising in direct proportion to the number of clinics offering FUE-only techniques. It's just that FUE-only advocates completely ignore the failures. I will only specifically comment on the techniques and instruments utilized. This way personalities and feelings are not hurt. That said I will say that every doctor you mentioned, including me, has had publicized poor results with FUE, and these results are a direct result of FUE injury. Your view of FUE is limited to the very very narrow window of chat sites. I see them all the time in my office and know what the problems are. The laws of physics are the same in every doctor's office. All you have to do is understand what they are doing and why and all the subjectivity goes out the window. But almost none of them are willing to be transparent. I am. Lorenzo is, even Dr. Bhatti is to his credit. But how did that work out for him? I'm sorry to keep seeming like I am picking on him, but it's not him that I have an issue with, I've never met him, it's his technique. And while I would definitely sit with him at a meeting and have a beer, I wouldn't let him near my head with his technique. I don't care how many before/after photos I am shown. Look at the latest Bhatti video of how he extracts grafts. Now compare to the Lorenzo video or my video? Which is more brutal? Which is more gentile? Which is faster? Which is slower? If online photos and results could be objectified we could use it as a gauge. But it's not that simple. Clinics will only put up successes (except for me. I've put up duds for years in the name education and reality and it never hurt my business). Most patients who are disappointed in their results are not going to relive that disappointment by posting them. Some do as a relief valve, or call for support or even as a "get even hit thread" against the doctor. But most just want to move on with their lives. So point to before/after photos all you like. They are not valid as a gauge. There are hundreds of old style plug results that produced just as beautiful before/after photos but i wouldn't have this procedure performed on me. There are also some awesome before/after photos of scalp reductions. But again, no way for me. And let's talk flap procedures. Miraculous results in before/after photos. Would you allow that technique to be performed on your head? How about a loved one? I hope you get my point. Read Micky's latest conversation with me on this thread. It is the most on point read in this thread, or any other FUE vs. FUT thread.

WELL DONE! WELL DONE!!! Even though you are not actually performing the procedure I can see that you have conceptualized them enough to understand the forces in play. Very impressive for a non-practitioner indeed. Let me go down your list: Neograft: Agree on every word. I'll also add that it is marketed as a 'turn key" system to allow non HT specialists to get into the field without all that pesky training, experience, and need to create, pay, and train a staff of technicians. I have seen this device in action and was appalled by it. Only Dr. Bhatti's recent video made me gasp more since seeing the Neograft in action. Neograft does not address the three detrimental forces. ARTAS: Agree on every word. However, your use of the word "compression" isn't the same as mine. But, you do bring up a force exclusive to ARTAS that I had not identified which is indeed a compressive force that bends the follicle as the cutting surface descends into the skin creating the perfect set up for a side shear. The ARTAS only scores the graft. Why do you need to spend a hundred grand or more when you can do it more gently and swiftly with a manual punch for fifty bucks? An experienced HT practitioner competent in manual FUE has no use for such a machine. ARTAS does not address the three detrimental forces. The compression force that I refer to is the squeeze on the graft applied with the forceps in preparation to pull the graft free from the lower dermis. The greater the pull, the greater the compression force. Harris Safe system: Agree on every word. But I will add that it does help control side shearing, but at the cost of greater torsional damage. I actually experimented with duller punches for the same reason he did, which was a good idea, but in the end it didn't really help in most patients. SAFE system does not address the three detrimental forces. I never used the CIT punch, but I think I saw a comparison between it and one of my punches and it was found to be even sharper. Well, if that's true then it's a damn sharp punch. And as Rassman discussed 13 years ago a very sharp punch is a requirement for FUE for the reasons you cited. Less torsion. But it has no effect on the needed compressive force of the forceps nor the traction force required to tear it free. So this could be considered an improvement, but sharp punches are hardly an advance. Nevertheless, I agree with the benefits of a sharper punch over a duller punch. Especially if we incorporate your definition of compression (which we need to rename to include in the list of FUE detrimental forces. I'll leave it to you to name it and we'll use your terminology moving forward). Dr. Lorenzo is the only FUE-only doctor I have met and not had an argument/debate with. Despite the hideously inaccurate things mentioned on his website, he himself in person was very candid and accurate about the differences between FUE and FUT. Actually, I found him to be breath of very fresh air. He is also the only FUE doctor other than myself who came up with what could be called a refinement in FUE technique. His method or "tricks" as he calls them allow for a better distribution of force during the "delivery" process of FUE. It is well thought out and has actual practical application. In short, it works and is an "advance" in my book. HOWEVER, while his forceps compression force is reduced in this manner, it has almost no effect on the traction force. I say almost because it does force the doctor to be more patient to allow the graft to break free at its own pace thus reducing to some extent the traction damage-but not force. These tricks have no effect at all on the torsion force at all. It is a "trick" that allows the practitioner to extract faster with less damage, and that's good. Unfortunately, even these tricks still do not elevate FUE to the level of FUT in reliability and consistency. But at least it's better than ripping them out wholesale without regard for compression damage in the name of speed. I have utilized this technique myself since meeting with Dr. Lorenzo to speed up my own procedures, but still chide at the traction and torsion damage. An advantageous trade off though. My punch and my perforation technique are the only true "advances" that I know of that actually address any or all of the three main detrimental forces. And they are simple. Not hundreds of thousands of dollars and very common sense. My punch is called a "relieved" punch which means it gets wider as the graft moves past the cutting surface into the punch. This makes it harder for a seal to be formed and thus weakens the cohesion between the graft and the punch. So when the punch is turned the graft won't turn as much with it. This relieves Torsional damage. But even with this advance, torsional damage is still a force to be reckoned with. Just look at the amount of decapitations or "capping" that occurs during all FUE procedures. This is an immediate transection that is a direct result of torsion force and still happens with my punch, albeit to a lesser degree. A sharper punch like the CIT you described also reduces torsion because of the fewer turns necessary and the less twisting required to work the edge down to the 3 mm point. Then there is my perforation technique. Which is simply a needle pushed to the bottom of the graft before it is pulled to reduce the strength of the tissue and thus the traction force necessary to tear it free. See the animation and demonstration in the links.(I"ll put these in later) http://fellermedicaldata.com/fellermedical/video%20for%20site/FUE/animation/fueanimation.gif The problems with my techniques is that they don't speed up the procedure. Putting my punch on a motor does. So I built one and marketed it. But over time I found I could do a better and faster job manually. We need a completely new way to look at the problem. But I'm about out of ideas. But if you or anyone else can come up with a way to reduce the three detrimental forces AND speed the process up you will be an overnight hero and multibillionaire. You have some homework now, Mickey. You need to come up with a term other than "compression" to describe what happens when the punch pushes down the graft while still in the skin that causes it to bend thus allowing a greater chance of shear damage.

Mickey, Let me answer your question with a question: What FUE instruments have come out in the past 14 years that to your mind reduce any or all of the three detrimental forces of FUE: Traction, Torsion, Compression ? This may be the most on-point and important discussion to date on this thread or any other concerning "advancements" in FUE technology. I thank you for asking this question and look forward to your considered response.

Can you and your ilk possibly tone down the childish nastiness and "gotcha" language? Would you speak to someone like that in person? I should hope not. If you weren't so intent on "winning points" you might learn something that will change your world view. Show respect and I will entertain your questions. You are free to not like what I have to say, but I speak from experience and authority that you do not possess. Like it or not, that's the case. I'm not the evil villain spinning my mustache in my cape and top hat. I am trying to help you and everyone by giving you information you can't possibly have and so many doctors refuse to offer. It is human nature to try and find better ways to do things. Not because what we are already doing is bad, but because improvements are simply better. However, not every effort at improvement is going to succeed. FUE is a great example of that. FUT is not "broken" but it can be improved. The primary improvement WOULD be to minimize or eliminate the scar. I agree with this. But only if this can be done without creating even more negatives like greater scar tissue damage throughout the donor area and decreased growth yields as a result of extraction damage. FUE is an alternative procedure but NOT a substitute for FUT. It has it's place in small procedures and in patients who don't have the donor characteristics for FUT. This is why I actually invented instruments and protocols for FUE. It's why I studied the procedure and boiled it's negatives down to three fundamental shortfalls. I see FUE is a patch. You may put one or two or even three on a pair of torn pants, but you wouldn't realistically make an entire pair of pants out of patches.

Wylie, That is a nice write up, but it is based only on wishful thinking and a hopeful parallel to improvements in production technology, not medical technology. If you replaced the word FUT with "carburetor" and the word FUE with "fuel injector" then you would be correct. But medical improvements are far more resistant. The first myth is that FUE is new. It is not. It is now over 14 years old and still has not caught on. In contrast, FUT was "invented" in the late eighties. Within less than 5 years it swept the globe and put HT on the map. There was no internet back then and yet the ranks of HT doctors who accepted and learned FUT swelled literally into the thousands almost over night. So many doctors readily adopted FUT that the ISHRS was born and had it's first meeting in 1992. I joined in 1993 and watched the industry develop and grow into a juggernaut. FUT has a "rightness" and an "elegance" that FUT simply doesn't possess. With three times the amount of time in existence FUE has still failed to launch as a primary procedure. It is not because FUT doctors are lazy or the procedure is too hard. It's because it doesn't work as well. It has it's place, but not as a primary modality. For all the smoke and mirrors and distorted information put out there by FUE only adherents, that is the reality. It doesn't work as well as FUT. By the way, it is sad that so many non doctors mock FUT as simple or easy. It surely isn't. It is more difficult to perform than any FUE and requires far greater surgical skill, competence, confidence, and the ability to create and work with a team. That reality has gotten lost in the mire of FUE hype and bluster. Wilie, you wrote that between the choice of having a scar and not having a scar the answer is obvious. What you left out was the more primary choice of picking a procedure that gives the greatest chance for growth for the greatest amount of grafts with the least damage to the donor area. The mission, after all, is to cover bald skin. Your choice is not realistic because it comes at too high of a price. A price that is ignored or not mentioned by wishful thinkers and patients who are frightened of the FUT procedure. If you think the doctors who perform the surgery don't want the smallest most invisible scar possible then you have no idea how most surgeons think. FUE is not "coming". It has had 14 years to achieve dominance, and yet to date it hasn't even reached parity. The reason is simple. When it comes right down to it patients want the best growth possible in their recipient areas and are not so concerned about a linear scar that will be easily concealed under the hair. Even with the online scare tactics of FUE-only advocates, patients still know intuitively that the more hideous scars are outliers, not the norm. As this scare tactic is exposed for what it is and the chances of scarring put back into proper perspective FUE will lose more ground to FUT. FUE hype is always based on the claim that it is a NEW procedure. But it has now been around 3 times as long as FUT was when FUT took over the world. People are getting wise and realizing that it isn't "new". Knowing this is inevitable, FUE only adherents try to claim or imply they have NEW FUE technology. But that's not true either. FUT will continue to grow as FUE continues to sputter along. It will not completely die out because it does have it's place, but not first place. PAX FUT ! Strip scars:

I don't think PRP has any place in HT. And I believe it injures the recipient area with fibrosis if used at anytime prior to an HT. What could drive down the cost of FUT? I can think of nothing except perhaps a machine that can divide the grafts out of the strip as safely as a human can. To date this technology does not exist and is beyond human ability to create. What could cut down the cost of FUE? Well, the cost in injured grafts has to be reduced first. To do this new technologies have to be invented. To date, the only technologies that have evolved only make the procedure faster, not safer. Or, makes it easier for novice doctors to enter the HT field. To make it safer a revolution in technology needs to be invented. That's why I boiled FUE down to the three detrimental forces: Torsion, Traction, and Compression. Anyone who will address those forces and significantly overcome them will become an overnight hero and Billionaire.