Dr. Alan Feller

Amen. A rational and common sense statement of reality. Well done!

I'm sorry, Dr. Bhatti, but that is an extremely scarred and fibrosed scalp. Where as the scar and damage would have been confined to a few millimeters in an FUT procedure, in your FUE example it is everywhere. I can see even from that very complimentary picture the confluence of scar throughout the donor. When one looks close there is so much confluence of scar it looks like punches of 5 mm or more were used in areas. I'm sure they weren't, but as the smaller scar coalesce they form groupings of scar tissue that gives that appearance. I hope he grows well, but he would have been far better off with FUT not only because it would have greater growth yields in the recipient site, but it would have left the rest of the donor area virgin for surgery in the future.

But don't you see HTsoon that you had to show a completely shaved photo to make your point? FUT does not make the claim that you can shave your head. It's FUE that makes that claim, and it's simply not true. I don't know about that huge scar at the top of the donor, I've never seen anything like that before. But the linear scar in the donor below probably is from an FUT and is EASILY concealed when the hair is not shaved. He could even do a fade cut right up to the bottom border of the scar. You are so concerned with "winning points" or "gotchas" that you lose sight of objective reality.

Quite true !

Actually, this is typical FUE scarring. You are just focusing on the inferior donor area and the nape of the neck where the scars expanded and fibrosed. Now look into the proper donor area above. It is massively thinned out. Now imagine that the grafts that were wrongly taken from the nape were actually taken from the proper donor area instead. That area would look even worse. The more FUE grafts you extract, the greater the extent of the donor damage.

This is an unhappy FUE patient who posted his own photo unsolicited on this very site. At least we agree on a few things about this case: 1. It was performed via FUE 2. It is an unacceptable result 3. The extractions never should have been taken from below the donor safe zone 4. Nape hair grows poorly and should be avoided I do not believe the punch used for this procedure was larger than 1mm. In fact I think it was a .8 mm because if you look at the extractions this doctor actually took from the proper donor area above the nape the punch holes look much smaller. The punches just looked bigger at the nape of the neck because the skin was more flexible and stretched/fibrosed more during healing. Even with a small punch this case produced a lot of fibrosis. Grafts were taken from the inferior donor zone and nape which should not have happened. But this practice is all too common among FUE megasessioon practitioners and is in evidence in just about every megasession case. But let's say this doctor DIDN"T extract from the nape or inferior donor zone. Then this would have meant he would have had to take even MORE grafts from the proper donor area. More punches means less space between extractions and more inflammation and fibrosis during healing. So in this case the bulk of the scarring would have been shifted from the nape of the neck into the proper donor area causing the same moth eaten effect, scarring, and thinning of the hair. There is no way around this problem unless you do fewer extractions. And fewer extractions means moving away from megasessions.

No, unfortunately they would not. Acell is powdered pigs bladder and has no clinical efficacy that I have seen to date. Yes, I heard the story about the guy whose fingertip regrew with Acell, but never anything before or since. To me, it's just an unnecessary foreign substance being introduced into a fresh wound that would more likely inflame the tissue. PRP would absolutely make the situation worse. PRP stands for Platelet Rich Plasma. That means that one of the prime elements of clotting and fibrosis are injected in concentrated amounts right into fresh donor wounds. This would produce hyper scarring. Besides, do you know how PRP is "activated" ? It's done by injecting an area with PRP and stabbing it hundreds of times with a needle. This multiple stabbing alone would add massive fibrosis to the tissue. Not a good idea. If there were something that could reduce inflammation I and everyone would be using it. Steroids and antihistamines have been tried by me and MANY others, but they don't appear to do anything. Skin is living tissue, and it's very sensitive. It has to be, the slightest break has to met with a vicious response lest an organism get a foothold in the body. During an HT the skin doesn't know it's in controlled and antiseptic conditions, it just thinks it's being attacked and breached so it responds with massive inflammation and fibrosis each and every time. There are no exceptions. The more stab or cut the skin, the more it reacts. That's why FUT is superior to FUE. The "attack" is limited to a small area, and most of that area is actually removed. So there is about a ten fold less surface area for the skin fibrose over during healing compared to FUE. Come up with a way or chemical that will allow the skin to heal normally but not become inflamed or fibrosed and you will be an overnight BILLIONAIRE, and a 6 month TRILLIONAIRE. Look at the photo in the thumbnail below. See that wide area of scarring? Well obviously the FUE doctor didn't actually puncture every square inch with his punch. He only had to punch a small percentage of the area and fibrosis and confluence of fibrosis did the rest. This would not have happened in your average strip closure. All the grafts would have been taken from one area and then sealed leaving just a line instead of that mess.

Euro, Take a look at this man. Did FUE give him the ability to "back out" of looking like he had a hair transplant ? How would he cover that FUE donor extraction fibrosis ? The answer would be to grow his hair a bit longer. But that is the same exact remedy for concealing an FUT linear scar. The difference here is that the FUE recipient now has far more damage around the FUE scars because there are far more of them compared to FUT. Choosing FUE as the "back out" procedure is simply not true because clearly this man cannot shave his head and pretend like nothing happened. By the way, this is the NORM for FUE megasessions, not the exception.

No, you've got it backward. Should a linear scar stretch or become "hyper scarred" the FUT patient can just leave his hair at a normal length and it will easily be concealed. It is the megasession FUE patient who runs into trouble because to remove that much hair from the donor site requires a wide area approach that necessarily thins out the area to a cosmetically noticeable level. And that doesn't even include the shock loss that accompanies megasession FUE. If you are not sure where the shock loss is on such patients, if you have chance to view the donor area of an FUE megasesion recipient just look at the fibrotic and disrupted nature of the donor area. It won't take long even for an untrained eye to spot it. Also, you analysis neglects the most important reason for having an HT : hair growth. FUE handicaps the grafts through trauma inflicted by the extraction process itself. FUT has no such detrimental forces of dissection and no equivalent. So growth is better for FUT. Finally, most FUE practitioners today are HT novices. They buy what seem like high tech machines and think FUE surgery is a "turn key" business. Take the suction FUE machine users, they are the prime example. I believe these practitioners don't even know what they don't know.

Apology accepted, Seth. Just goes to show that everyone needs to be careful who they pick for their doctor no matter which procedure you favor. I didn't know at the time how inexperienced my first HT doctor and his staff were and thus I had 50% growth. Even FUT in the wrong hands can produce dismally low yields. I honestly think this site helped to clean up the FUT field by exhaustively parsing out and publicizing the details of the FUT procedure itself and naming which doctors performed which techniques. That made the procedure improve REAL fast. Back then people were truly interested in the technical details. But not anymore. Not with FUE. The analysis and intellectual curiosity and discussion has been replaced with a caveman grunt and a wagging finger pointing at a few good to mediocre results. When asked about poor results the response is usually nothing or in a captain caveman voice: "nothing see over there, move along!" By the way Seth. ALL surgery scars you for life. FUE is definitely included in this category. But FUT gives you a greater chance to cover up the scar after a megasession.

Incorrect. I had one unsatisfactory FUT procedure over 23 years ago by a low end doctor who doesn't even perform HT anymore. Despite this I did not have a large or regrettable scar. I also do not "slam" FUE. You are projecting. I perform both FUT and FUE. It is you and other FUE-only advocates who "slam" FUT every chance you get. Don't you ever tire of tearing things down instead of building them up? You are pure negativity on these threads. It's your view or no view, right? In truth, most of the opposition to FUT is blind fear of the procedure itself, not the normal and easily concealable scar it leaves behind. In reality it is FUE scarring that causes more damage to the skin and the remaining donor follicles limiting overall available follicles in the future. The formula for hair transplantation is simple: Do as much FUT as possible, then finish with FUE.

No, I do not believe that you or the other posters on this site have enough information at your finger tips to form an INFORMED decision concerning FUE. That's the problem I am trying to set straight here. You look at an FUE result and think it's either cosmetically significant, or it isn't. When I look at the same result I think the same thing, but I also wonder how many grafts were sacrificed to get that result. Just like when one magician watches another magician perform. He's see much more than the average audience member or magic enthusiast. It is not a comment on intelligence, it's a comment on experience. I am one doctor working in one clinic, this is true. But the laws governing FUE exist in every clinic. I don't care which clinic I walk into in the world. If I bring a video camera and film that FUE surgery you will see decapitations, failed attempts, and transections. And that's just the damage you can see. There will be more damage you can't see. All the result of the three detrimental forces I have been describing. The only real difference will be which doctors admit to it, and which don't. As sure as I know a train wreck will kill some people and injure even more I KNOW FUE will damage grafts. So to be able to produce anything like the consistent results FUT does an FUE clinic MUST implant more grafts to make up for the shortfall. You wrote:I have spoken with dozens of doctors who feel strongly that in their hands, yield is virtually the same when they perform mega sessions versus regular sessions. I beg to differ with them. The forces that act on FUE are no different in their office and hands than they are in mine. UNLESS they are claiming to perform a different technique with different instruments. Which none do. There is scoring and there is pulling. That's it. The difference here AGAIN is that some doctors admit this, and other don't by trying to snake around the question as much as they can to maintain the implication that they are doing something different and are therefore "more advanced". Also, what is THEIR definition of yield? Is it the same as yours? Does it include the failed attempt ratio? Injured grafts? Transected grafts? I doubt it. Amazingly, I have heard FUE doctors claim that "the grafts that grow grow as well as FUT". What they really mean is the grafts that SURVIVE uninjured will grow as well as FUT grafts. This is of course true, but this definition excludes very conveniently the grafts that don't grow or grafts that were transected during the extraction attempt. I think because you don't perform these surgeries that you are not familiar with the variables and so can't come to an informed conclusion. And not surprisingly, many of the FUE doctors you are talking to also aren't aware of them, or, they are aware of them but play them down, or, they are aware of them but don't care-they' just grab more grafts. Finally, if FUE were anywhere near as good as FUT, then why hasn't the entire HT doctor population switched to it? It's been FOURTEEN YEARS ! Why would there be clinics like mine that offer BOTH, but still do mostly FUT?

I happen to agree with this statement. But can you expound on it, please? And if you have a moment, can you tell us what it was in your consultations that either interested you or put you off HT? Thank you, Dr. Feller

Amen.

Sure HTsoon. If you can come up with 3 detrimental forces that negatively affect follicles as much as those as FUE then I am all ears. The stage is yours, go.

This forum must think your posts are twice as important as anyone else's. You should be flattered.

"One issue to consider is speed and the ability to do FUE megasessions without sacrificing yield. The question is, does this ability make one physician better than another? Perhaps speed and the ability to do FUE megasessions should be a Coalition standard for FUE? What does everyone think?" Considering speed as an "ability" is destructive, Bill. By definition increased speed must mean increased damage and decreased yield. Considering speed an "ability" means rewarding rushed surgery. Thus, the inverse becomes true as well: the slower and more considered a surgeon treats the extraction process the more he is punished. There is no area of surgery where the doctor is punished or rewarded for racing the clock. Rushing through a case is a golden ticket to a medical malpractice lawsuit. Instead you should implement a definition of "ability" based on verifiable technique. This is the only true objective way to gauge actual FUE ability.

I did miss your post. Here goes: 1. What weight loss? Are you implying I was fat?!!! I lost 55 pounds in 10 months by doing two main things. No joke. The first was cut pizza almost totally out of my diet. The second was I walked outside 4 miles per day no matter the weather. That's it. No running, no harsh dieting, no strenuous exercise. Thank you for noticing. 2. I have had Three HTs. The first was to my hairline which did not work well. The second was to my hairline and top. It worked incredibly well. The third was to my posterior top and anterior crown. It worked ok. But in all fairness not a lot to work with. I'm very happy with my results. 3. An ARTAS rep would show up at my office every now and then to sell me on the machine. Very nice and amiable guy, but I just couldn't see the point in buying one. All it does is score around the graft for a few hundred thousand dollars. Well, I can do that for $50 with a feller punch and do it faster with greater care. The only ARTAS results I've seen have been online and I have not been impressed at all. By now I would have thought they would have a huge catalog of great results. But no. At first I thought it might have a place in the office of a novice HT doctor in that the technology could make up for the inexperience of the doctor. But so far it hasn't done that. Hey, if this device worked as advertised I'd buy ten of them and do ten cases at a time and perhaps program one to make me coffee so I can kick up and read the paper while the machines did my work. But nope. Not happening. As far as comparing the ARTAS to those doctors, I suspect that they would all create the same amount of scarring if they performed the same number of scoring attempts. I say attempts because not all extractions are successful. And while you may not be rewarded with an intact graft, you will still definitely get the donor scar and subsequent fibrosis. As far as yields it extends passed the machine. The hard part in FUE isn't the scoring, it's the "delivering" of the graft. Since the ARTAS users are more likely to be inexperienced next to the other doctors you mentioned (or didn't mention) I suspect their yields would be lower.

Bill, The only way for FUE to improve is for new practical technologies to be invented. To date they haven't been. I got the 75% number by simply looking at the results of FUE patients, both mine and others. Actually, I think the number is lower. You are correct that we can't go into physicians offices and collect the data ourselves on growth yields. But we also can't look to patient results either because they are very variable in and of themselves. And, most importantly, we can't tell how many grafts were used to achieve a particular result. The only way to evaluate where FUE stands with respect to FUT is to compare the procedures themselves. And that's pretty easy. Look at the Bhatti video and look at the Feller video. Look at the Lorenzo video, I've seen that bounced around too, and simply compare using common sense. The more in depth stuff is addressed rather deeply in my posts right here on this thread.

You still haven't answered my question. Did you or did you not see a video of your doctor's technique BEFORE your procedure? Which video demonstrates a more gentile technique to your mind? His or mine? And since your wife is a doctor, what does she think of the way tissue is being treated in that video?

Oh, I see, your challenge is much more genuine (sarcasm). You want to compare the number of patients who come through your doors daily with prior FUT work seeking repair compared to the number of patients who come through my door daily with prior FUE work seeking repair. Did you happen to note the name of this thread or read the first post? Obviously there is far less FUE out there as there is FUT. You must know this. So how is this anything more than a disingenuous challenge? With respect to the video, did you actually see how your doctor performed the procedure before you signed up for it? Did he inform you of any differences in expected yield in general between FUE and FUT?

I think there are very few doctors who won't at least take a mental note of the success of a prior transplant when the hair is shaved down in preparation for a second procedure. You really have to as the doctor because in the second procedure you have to be careful to go between the grafts of the first procedure and thus be aware of the density. When placing new recipient sites between prior FUE grafts this is usually much easier because there are more spaces. Unfortunately, there is also more fibrotic tissue representing grafts that were implanted, but didn't grow. And in patients who have had body hair transplants it's like implanting into a fibrotic minefield.

What scare tactics?! Your doctor posts an unsolicited shaved donor area with an FUT scar in it out of the blue with no explanation for it and have the nerve to innocently ask "what scare tactics" ? Do you really think I and the viewers are so na?ve? And as for your disingenuous "challenge" I clearly DON'T perform daily FUE cases because I find them to be too damaging to the grafts and unethical in most patients. Now you know this, that is the very basis for this thread and most other FUE threads I've made. The real challenge is in comparing techniques not how many patients you can inflict FUE on per day. Your doctor posted a hideous video of grafts being removed haphazardly and in haste. My video, on the other hand demonstrated a paced and delicate procedure. I win. Hands down. By the way, gotten many kudos on the performance in that video? Here's another link to that piece of work: You never did give your comments on it. Would YOU want that done to your grafts? How about to a loved one? Also, this thread has over 41,000 hits so I don't think interest is dropping at all as you're doctor is claiming. There are more hits each 24 hour period compared to the previous 24 hour period.

The way I became sure about the yields of FUE in general was when I operated on patients who had already had FUE in the past. Either with me or elsewhere. I would note how many grafts they received, or told they received, and compare it to the number I counted when I shaved the hair down in preparation for the recipient sites. In the end, adjusting for telogen hairs, I concluded that the average was about 75%, and the best I'd seen on any kind of semi-regular basis was 85%. In Destorious's case I just took the information he offered in his post and did some math. So I put FUEs into both sides. One side he said grew fine. So let's say that represents 100%. The other side he calculated only grew 50%. So if you crunch those two numbers you wind up with a 75% overall average yield. The reason I pointed this out is because I have claimed for years and years that 75% is about the average growth yield for FUE, and here is one of my very own patients whom I haven't talked to in years stating quite unknowingly that he felt his own yield was in fact 75%. What's even more interesting about his post is that he is not surprised that his results were not 100% or even near it. This is because I made absolutely sure he understood the variability of FUE as compared to FUT. And, I made him read an informed consent document that states the disadvantages of FUE very clearly that he had to acknowledge and sign before I would perform surgery on him. So he knew I was being a straight shooter with him before operating on him. And like he said, he knew the risks and rolled the dice. Sounds like he did ok, but if he wants to fill in the weaker side he will need to do more FUE. And so it goes with FUE, the need for filling in and "touching up" is insatiable compared to the equivalent FUT.