Dr. Alan Feller

California, You neglected to tell Bill that photo I posted was in RESPONSE to Dr. Bhatti's original photo. I didn't initiate this disingenuous distraction. If you and your doctor want to continue this pointless cycle I have plenty of hideous FUE donor results in my databases. Or you can simply stop the not so thinly veiled scare tactics.

Thank you for the kind words and the follow up. I think your post is dead on. It's interesting to note that you basically wrote that one side grew well and the other only about 50%. So when I ran the numbers you had 75% overall growth. And that's the exact number I claim that grows on average with FUE. Thanks for participating.

So Dr. Bhatti posted a photo presentation that includes the eeeevil linear scar- and is allowing it to speak for itself. But let's ask a question, would this patient have been better off with following megasession FUE scarring instead? So let's listen to what Dr. Bhatti's photo presentation is actually telling us: 1. The scar was completely concealed before the donor area was shaved down. Can the same be said for FUE guy? 2. The donor area above and below the scar are completely virgin. See any virgin area in the FUE guy's donor area? 3. Dr. Bhatti can now perform a hair transplant BECAUSE the donor areas above and below the scar were spared by the FUT procedure. Can he get NEARLY as many grafts out of the FUE guy? I have focused most of my efforts on this thread in pointing out the three detrimental forces of FUE. But I only just touched on the increased donor scarring and damage that FUE inflicts on the donor area over FUT. The more the donor area is damaged, the less hair one has to cover that damage and the less hair available for future procedures. Add to this the fact that the 3 detrimental forces cause a decreased yield in FUE cases and the choice between FUT and FUE becomes pretty easy.

In our last video we discussed a patient who could by all rights be called a slow grower. Today we present a fast grower. This patient had two procedures 15 years ago that simply did not grow. So we used more modern techniques to cover his bald areas. He visited at 6 months and the difference was already impressive. www.youtube.com/watch?v=BbJ2NvxX-FY

My definition of honing my skill is getting grafts out with more tissue and less trauma. This is working smart and represents a true advance. The definition of most other FUE doctors of honing their skill is getting the grafts out FASTER and FASTER in greater numbers with no regard at all for graft injury or donor area sacrifice. This is a "brute force" approach and does not represent any advance. Your doctor took the right path. By doing 900 per day he took his time to do it right. THAT is working smart, and more inline with my philosophy of surgery. In taking that route he spared you hundreds of grafts and considerable donor fibrosis. I love doing FUE, it's quite a challenge. And I must admit that I am always on the look out for a better way to do it. In fact, one idea came to mind that I thought of a few years ago but never tried. Very different and counter intuitive. If I actually build it I will, as always, post it here. Maybe it will be "the answer".

Unfortunately I did not overcome the three detrimental forces of FUE. I diminished them a little through true and actual advances in instrumentation and technique, but not to the level of delivering an FUE graft that is as intact and uninjured as an FUT graft. If I had, I would only be doing FUE. But this is not the case. The gold in your last post is that you are recognizing what I have been trying to say, and that is that if you are going to have an FUE procedure then you have to know, acknowledge, and consent to the reality that your grafts are going to be injured to a greater extent than that for FUT and will thus need more grafts transplanted to achieve the same cosmetic look. The three detrimental forces of FUE have been identified and proven to exist, even if many FUE doctors refuse to admit it. Torsion is evidenced by the immediate decapitation that occurs during the scoring process. Traction is evidenced by the missing lower half of grafts that are removed, or lost parts of the lower half, or outright transection Compression is evidenced by the crush injury that can be seen when the graft is removed from the scalp All are in evidence and to try to minimize their significance is to go against 25 years of Hair Transplant gospel. Graft handling and preparation has always been at the heart of high yield hair transplantation. That doesn't go out the window because a few dozen practitioners decide it does. In order for an FUE procedure with all it's involved injury to grafts to consistently produce results on par with FUT it must utilize more grafts during the procedure. The more the better. But this is only because so many are injured or killed in the process of extraction. Yes, you can point to a megasession recipient and say he looks great and thick. But he most likely needed more grafts to achieve that look because so many were injured in the extraction process. Specifically due to one or a combination of the three detrimental forces.

40,000 HITS! Who would have thought this thread would run this long?! There must be some interest in the subject.

Ha! Yes. Props on your math!

You're right. I misread it as 99% not 99.9%. I meant to write 99%. Got it. Guilty as charged. Thank you.

My mistake. You are correct.

Sorry Vox, check your math books. Here's my original post: "Originally Posted by Dr. Alan Feller If every doctor who performed a hair transplant surgery tomorrow were to check in on this forum and tell us what HT surgery they performed on that particular day you would find 99.9% would be FUT, not FUE." 100% means 100 out of a 100 99% means 99 out of a 100. -so- 99.9% means 99.9 out of a 100. Not 1 out of a 1,000. You are off by an order of magnitude.

Props to you Matt. Well done. A person needs to be a bit more of an engineer to understand the facts and forces I am trying to reveal. You clearly get it. The tension force that you are referring to that is caused by the adhesion at the base of the partially released base IS the TRACTION force I'm referring to. So only three forces. By using follicular perforation this adhesive force can be reduced and thus the required traction force can be reduced as well.

I'll tell you how: I utilized a very meticulous FUE technique to reduce the three detrimental forces. 1. I scored with a manual punch and did small angle oscillations allowing the punch to work it's way down into the dermis at it's own rate. No forcing in the name of speed. And certainly no rotary drill. This reduced torsion and heat. 2. Then I grasped each partially freed target graft individually and carefully and applied gentle but constant traction. This allowed the graft to work itself free at its own pace rather than being ripped out violently in the name of speed. 3. To decrease the traction force I slid a small needle into the scored opening and poked at the base of the still attached graft. This perforated it and allowed the graft to pop free with less traction and therefore trauma. See the video below. 4. Since I could apply less traction I could also apply less compression to hold the graft while delivering the graft. 5. As I delivered the graft I made sure to stay in the same line of traction the entire way. I didn't just yank and rip them out in any old direction in the name of speed. Nor did I attempt to score a bunch of target grafts and then try to grab them together as a clump and tear them free together in the name of speed. 6. Each graft was taken from the field one by one as they were delivered. I say "delivered" because I liken this procedure to delivering a baby. In child birth the doctor doesn't just grab the head with forceps and rip the baby out with great force because he has another birth to attend. This is the technique that I use to deliver FUE grafts. In many cases it works well and the growth is impressive, even in a "hostile" recipient environment like a scar as seen in the repair case above. But even with all this caution and care patients may still fail to grow as satisfactorily as the equivalent FUT procedure. This is why I say no matter how good or bad a result from FUE appears to be, the result on the same patient using FUT must be better because there isn't as much trauma to the grafts. In the case of the FUE repair case above he happened to grow well. But if he hadn't, the chances are more likely that the decrease in growth would have been due to the three detrimental forces of FUE. If you can't overcome these forces then you have to get around them. The only way to do that is take more grafts than you otherwise would need to for FUT. And to do that you'd have to speed up your FUE procedure. And the faster you speed up your FUE procedure, the greater the detrimental forces are amplified. THAT, in a not so nutshell, is why I oppose large FUE sessions.

I think you meant 1 out of every 99 Does anybody even read the first post of this thread ? This clearly explains why.

That sums it up rather well. Distraction, evasion, scare tactics, and personal attacks.

Well I think we can all agree on two things: 1. This patient's scar is very very unusual and not even close to representing normal everyday FUT scarring. It's pretty obvious he suffers from a genetic over flexibility of the skin. If he's the same guy I saw in another thread the large wide scars even in the recipient site confirm that. 2. He is a PRIME patient for FUE and is, to my mind, the sole reason FUE exists. That is, to have an alternative treatment for patients who cannot nor can no longer have, FUT surgery. I suspect even his FUE scars will be more prominent than in the average patient. Considering the size of that scar, though, why not implant into it? That's the perfect scar for it. Standard FUT scars don't transplant well due to the fibrosis and lack of vascularity. These scars tend to be thin, less dense, and loaded with vascularity-or at least able to grew new vessels far easier. Here's a presentation I did of the worlds first FUE into scar I did back in 2003. Worked like a charm:

I didn't see how your procedure was performed, nor have I ever watched your doctor's technique. But let's say that your doctor used a delicate and paced technique, then NO I don't think an FUE by me would have minimized graft damage or made a difference in your result. So what happened with you? Well, it was one of two things most likely. Either your grafts were extensively damaged during the FUE process despite careful and excellent FUE technique; OR, your physiology prevents you from growing well. The so-called X-factor. If you do a strip procedure and it grows well, you will have your hair and your answer.

David, Unfortunately Dr. Bhatti is incapable of staying on point as usual. I don't address him directly anymore because he had his chance and chose to play games instead. By the way, he still hasn't retracted his false charge against me. Nor apologized for it. If I believed FUE procedures were as good as FUT procedures I would be doing them everyday and happy to post the results. But I don't for the reasons I made this thread. I've already been down this road ten years ago, I know what happens. You cannot compare results of different people and different doctors easily, that's why I don't bother doing it. Or shall I start posting photos of patients who have experienced the poor growth with FUE that I predicted. There is no shortage of them on this site. Instead, it is much more direct to look and study the method used to remove the grafts. It is common sense, no matter how much someone tries to blur the lines. that mishandled grafts will not grow as well or as consistently as more delicately handled grafts. In order to overcome the loss from mishandled grafts one must take and implant MORE hair than is necessary. This also means more donor scarring. So if the discussion is focused on the different detrimental forces that act on the follicles, rather than subjective before/after photos one can come to a VERY scientific conclusion based on undeniable and observable information. That video Dr. Bhatti posted IS that undeniable observable information. In a scientific debate it isn't the "ends justify the means". It's study the process from the ground up and look for the flaws when compared to another method. So look at the poor FUE results out there. What happened if not graft injury? If a doctor or inventor can come up with a way to get grafts out safely , much less quickly, then I would adopt it in a second. But nobody has done this to date. Nothing has changed in 14 years. Yes, if you do enough cases you will have enough good cases to APPEAR to be improving on the FUE procedure. But a look at that video shows everyone that this is not the case.

Ezel, I read though this thread quickly but did't see any reference to you switching to an FUT which is almost a lock for successful growth from what I can see based on your photos. There is no mystery what happened to you. Your grafts were most likely damaged during the FUE extraction process. So DON"T do it again. Instead, go with an FUT which is far more delicate on the grafts. I think you will find a world of difference in growth. I'm sorry this happened to you, but it is more common than is presented on these chat forums. Switch to strip, enjoy your results, and get on with your life. Best, Dr. Feller

Curly hair is the hardest kind of follicle to extract because the graft is actually curved like a hockey stick. So there is more injury when removing them. I know you are worried about the scar with respect to FUT, but you may want to rethink that worry as your best bet for better yield in the future is with FUT, not FUE. If your doctor places takes the strip from high up in the donor area you should be able to wear a high and tight with no problem. We have military patients and police who do that all the time. Works like a charm. Also, since you have black skin your FUE holes are going to heal white and begin to stand out. Another round of FUE will only accentuate that so you would have to wear your hair a bit longer anyway. Best to you. Dr. Feller

Lower yields from FUE are the norm in hair transplantation. This is due to the excess trauma that FUE places on the grafts. Some grafts can tolerate the extra stress, some can't as you found out. I've had many patients present to my office in your situation. I think doing a second FUE is a mistake since your first one did not work out so well. I would recommend you switch to FUT. This will be more a more delicate surgery and exert far less stress on you follicles. Place 1500 on the hairline and just behind and you should be right as rain. If you can get more than that, go for it. Best to you and your hair. Dr. Feller

Nobody "defends" me. I have had some supporters every now and again, but none based on deep emotion as the FUE supporters have demonstrated for their cause. It's very unpleasant to tell the truth sometimes and people don't want to hear it. I take a lot of hits for it. Nobody should have personally attacked your results. That was wrong and I don't support it. I try to steer clear of referring to individual results as it is hurtful and completely unproductive. Besides, every doctor has patients who don't grow as well as others. You are concerned that FUE issues are being discussed and FUT issues are begin swept aside. But you are treating the two as if they are both equivalents. Like they both just arrived on the scene at the same time and one is getting unfairly critiqued. But that's not the case. FUT already went though it's vetting process long before you got here and does not have to do it again. It is the proven Gold Standard of HT. There would be no HT if not for high level FUT.The FUT issues you are referring to are not issues, they are inventions. That has all been sorted out years ago. That's why nobody participates when a wild FUT claim is made by the FUE camp- they know it is hollow. People new to this site may not realize that, but the veterans and the doctors know it. The only doctors making issues out of modern day FUT are the ones who are trying to elevate themselves and their FUE practices. Fundamentally, the only "advantage" of FUE is lack of a linear scar, this has not changed in 14 years. That's the up side, but it inherently comes with a downside for growth and donor damage.This also hasn't changed in 14 years. And since MOST patients are not going to buzz cut their hair after a procedure, why take the risk of FUE? And after viewing so many results on this site alone it has become obvious that these patients can't shave their heads either because of the moth eaten effect caused by grabbing out so many multi hair grafts thoughout the donor area anyway. So that "advantage" is also diminished. So what's the point of FUE at all? If you are a person who doesn't care about more injury to the grafts and a lower yield and a more damaged donor area, then go for FUE. I'm a patient and an HT doctor. I only do strip on myself. Never FUE simply because I don't have the donor area to gamble with. Do you think I would pick an inferior procedure to be performed on me? Still wondering what your thoughts are on the technique shown in the Bhatti video. Would you consent to have that technique performed on your donor area?

Irish, Not to be concerned. I know exactly where you're coming from. I remember you well. You cannot cherry pick finer caliber hairs because what appears "fine" in caliber today may be quite thick tomorrow as the hair moves through the growth cycle. If one picks hair on the outside of the donor area, then those hairs are looking finer because they are dying. Think of these low areas of the donor as the "hairline" in the back. It too recedes and does so by miniaturizing the hairs first. Just as it does in the front hairline. That's why I've always chided when I read about HT doctors claiming to take hairs from the nape of the neck to produce finer hairs for the hairline. They are on their way out. That's WHY they are fine. Also, since you had already had a linear strip scar, I see no reason why you should have bothered with FUE. It wouldn't make any difference to how the donor area looked if you had gone for one more FUT.

HTsoon, Why have you assigned yourself as Dr. Bhatti's guardian? Such a loud and nasty one, too. Do you not think he can speak for himself and that he NEEDS your help? I think you need to lay back a bit. It's ok. Take a breath. This isn't a court room. Nothing is going to happen to your doctor. If you don't agree with what I"m writing you are more than welcome to laugh and walk away. If Dr. Bhatti has valid concerns about strip method or anything else then he can start his own thread and you can go with him. If it gets as many views, responses and interest as this one then it may have merit. But the issues he brings are up are not valid, not of concern to anyone, never been a thread of interest on this site or any other in the past, and are only invented and used as mere distraction. And he knows this. I haven't heard your opinion as to the content of Dr. Bhatti's video. Was it what you thought it would be? Any issues come to mind? or would you be content having that done to your precious donor area? Here it is again in case you missed it:

Correct! Without x-ray vision "cherry picking" is a myth, or more accurately, a marketing ploy.