Dr. Alan Feller

And here is the worlds very first public FUE extraction in 2002 performed by yours truly in my Great Neck office and published online-making it the worlds first online FUE as well. Note how gentile and purposefully the punch is oscillated into the skin. Then notice how carefully the target follicle is removed or "delivered" as I call it. I'm not being slow, I am waiting patiently for the lower dermis and fat to tear free so that I exert as little detrimental force of TRACTION that I can. Now compare this to Dr. Bhatti's delivery technique. Which do you think preserves the integrity of the graft better? And remember, I filmed that video 13 years ago!

Here is a video of me from at least 5 years ago performing the "scoring" phase of the FUE procedure using my oscillating motorized FUE device and custom punch tips. Look how I allow the tool to work it's way through the tissue rather than pushing it through. Also note how carefully I examine the target grouping before going for the next graft. Now compare this to the technique used in the Dr. Bhatti video. Which do you think injures the graft more?

Dr. Bhatti, I'm sorry Dr. Bhatti, but your procedure does not support any of the claims of advancement you've made on this thread. In fact, I find the contents of your video to be the most brutal FUE procedure I've ever seen. A layman can see how indelicate your method. There is a "wrongness" to it on its face, and you don't have to be an FUE practitioner to see it. To say you were racing is an understatement. The use of a rotating drill and indiscriminate grabbing and yanking the grafts free at high speed are hardly innovative or new. Indeed, this method has been around since the inception of FUE 14 years ago. In fact, there were no less than two megasession FUE clinics who are now banned from this site that performed their procedures the same exact way 12 years ago. One company of which produced a video identical to yours. So what is new here sir? Nothing. This is brute force and nothing more. No use of technology or advances-real or imagined. There is no feedback to the hand during scoring due to the weight and vibration of the tool, and there is absolutely no technique used to remove the grafts. No care either. They are just ripped free in any direction and smashed together with other grafts that were yanked free and crushed within the jaws of the forceps. While there are FUE practitioners who actually incorporate delicate and purposeful movements, feedback, and technique, this video of yours clearly demonstrates that you do not. You just score holes as quickly as you can and then tear them out as quickly as you can. This is not working smart. This is just working fast. The one bit of technology that you are using is the drill, but you use that simply to speed up the procedure, not reduce detrimental forces. That is not an "advance". You stated that there were indeed three detrimental forces associated with FUE but that "advances" in FUE had overcome them. The detrimental forces are in clear evidence in your video, but I see no "advances" in your instrumentation nor technique to neutralize them. Just the opposite in fact. The three detrimental forces of FUE clearly in evidence in the video (Torsion, Compression, Traction): Torsion: Every time you bury that high speed drill driven punch into the skin you create torsion. A twisting force that twists the follicle ever more as you proceed deeper into the skin. As you drive the punch down past the 1.5 mm depth the torsion has already started to do it's damage. Not to mention the heat that is created. You claimed in another post that you scored very shallow, but what I witnessed was a scoring depth down to 3mm. About the average for all FUE doctors. Since most grafts are about 4-5 mm in total length I think we can safely conclude from your video that you are scoring at least 50% down the length of the entire graft. That is the red zone for torsional damage. Compression: Every time your assistant blindly grabs the grafts after they are scored she applies the detrimental force of compression. However, in your method the graft gets multiple exposures to compression because she doesn't pull the graft free and clear it from the field. Rather, unbelievably, she just keeps squeezing the same grafts over and over again blindly as she attempts to grab a clump of grafts in one scoop just to save time. Traction: And the traction force is incredible. It's bad enough that there is a minimum amount of force necessary to break the grafts free in the first place, but your assistant makes it even greater by increasing the speed of delivery AND doing so at the worst angles. In the video the traction force can be easily seen by the tenting in the skin. To lift an area of skin in the form of tenting takes incredibly focused force on the graft itself. Greater traction force requires greater compression force as well. The removal of grafts via FUE should be an intricate waltz, not an unruly mosh pit. Look at what some of your better fellow FUE megasessionist do. They do not race, they give each graft its own attention and time to be delivered as safely as possible, they respect each graft individually and clear it from the field before clamping onto the next one in preparation for the next delivery. Your staff just blindly clamp and pull. Do you honestly believe you are not injuring grafts compared to a more delicate and refined FUE approach? Do you honestly believe this does not injure grafts to a far greater extent than an FUT graft that experiences no such punishment at all ??? Also, your video excludes the ability of the viewer to see the grafts AS they are removed. At the speed and distance from the camera that the grafts are being removed scrutiny is impossible. Also, when you showed the petri dish filled with tissue it is almost impossible to evaluate the grafts. Despite this, I could still see skeletonized grafts. At what point are you placing each and every graft under a microscope for inspection as you claimed? I do this. You claimed to do this. But I don't see where or how. You do not have it in your video. Dr. Bhatti, your one video did more to make my point about the damage FUE visits on each and every graft far better than I ever could have written or even demonstrated in my own clinic. I think MANY people watching this thread who may not have understood what I was talking about experienced an instant understanding and awakening. I look forward to the comments from viewers and other FUE practitioners as well. One final question Dr. Bhatti: Do you believe most FUE practitioners perform surgery this way?

Thank you for the kind words, Matt. Best of luck with your AA and your procedure when you finally have it done. Come visit us afterward. Best, Dr. Feller

It's ok FUE2014. Even though your link is not allowed, I still have an old brochure from before I sold the company and the patents. I'll attach it to this thread. Just click the thumbnail below. Ah, memories. That's from back in 2009! No contradiction at all. I see your post as supporting what I'm saying, not contradicting. That tool represents the very height of customized FUE tool design and manufacture to reduce or eliminate the three detrimental forces. But even it failed to bring FUE on par with FUT. I'm the inventor and I admit it. No other instrument, device, or system to date has addressed the three detrimental forces more specifically and obviously than my oscillating motorized system/Feller Punch combination you linked to. Not ARTAS, not Neograft, not anything. And that is my main point. Because there have been no advances that reduce the detrimental forces of FUE there can be no claim of parity with FUT. If a clinic or doctor is going to claim there has been an advance, then it is up to this person to demonstrate it. I just viewed Dr. Bhatti's surgery and he's doing absolutely nothing differently than other FUE only clinics who performed megasessions 10 years ago. NOTHING. But yet he insists he is. His own video reveals he is not. Rotating drill, standard punch, manhandling of grafts, and rushing through the procedure. Rush rush rush. This may be before Bills time here, but there were at least two FUE-only megasession clinics who are now banned from this site who did this same exact thing 12 years ago. Nothing new.

Thank you for the kind words, Nick. I agree with Dr. De Reys' use of manual punches. I actually developed a motorized tool but abandoned it due to the loss of "feedback", or as you put it: "feel". My best to you and your doctor. Dr. Alan Feller Great Neck, NY

Thank you Mick. Everyone one must realize that every person is different. We can perform the same exact surgery on 5 different patients with the same staff, in the same room, with the same type instruments, in the same time and yet get five very different levels of results. Some patients will grow earlier than others. Some patients may grow later than others. Some patients may not grow as well as others due to the tolerance of the grafts to the mechanical trauma of the procedure itself no matter how well and carefully it is performed. Hair Transplantation is all about the odds and doing whatever you can to massage them in your favor. This is why I favor FUT over FUE every time. The trauma exerted on the graft by FUE is orders of magnitude greater than it is for FUT and thus the odds are lowered by the choice of FUE. But the choice of clinic for your FUT is also crucial. If you go to one with less experience and a lower online track record your odds drop again compared to the more established clinics. And to be sure, there are HUGE variations from FUT clinic to FUT clinic. Same can be said for FUE clinics as well. For example, for the FUT clinic, is HT all they do? Does the staff of technicians work full-time exclusively for that clinic. Are they actually a team? Are "Traveling Technicians" used? And so on. This site has been stuck on FUE for so long it seems to have lost its way as a tool to discriminate between clinics of any kind, FUT or FUE. For now it's just those int he FUE camp chanting "FUE FOREVER" while those in the FUT camp are just disengaging from the site altogether or just contributing the bare minimum. Here, the false impression is that all FUE practitioners walk in lock-step. They do not, and the differences between these clinics should be made transparent by the clinics themselves so the participants and members of this site can make their own evaluations. Likewise, the differences between the ability of one person to grow faster or slower than another should also be made transparent and discussed and evaluated as to how much of the differences of success or failure between patients is due to patient physiology or perhaps shortcomings on the part of the procedure used or even the clinic that performed it. Let's point this site back in the direction of analysis and transparency rather than FUE camp vs. everyone else.

Not to me it doesn't. In fact, very often when attempting to get a multi hair follicular unit during FUE one or two of the hairs are avulsed leaving just a single hair graft. That's why I have all my FUE grafts examined under a microscope to see if there are damaged follicles or parts of follicles in a grouping. The techs cut away the injured parts and create a single hair FU out of it. I think I may have cut down the multi grafts of maybe two patients in my entire career to obtain a needed number of single grafts.

So how many doctors have 10 years of FUE experience? Anyone on this thread?

Dr. Vories, that is not likely to be the case. The cause of the poor results was in the extraction of the grafts - that is the most obvious weak link in the FUE extraction chain and the only variable I changed. In the case of my patient with the 50% growth he grew better after his second procedure than his first yet the placing was exactly the same by the same people and the same instruments. I don't care for implanter pens as they are bulky, cumbersome, slow, and expose the graft to too much downward compression force. Since it is essentially a needle on a handle the needle will dull rather quickly in fibrotic skin. Worst of all, doctors are sterilizing them instead of disposing of them which is fine if it is a regular surgical instrument. But these things have lumens which can't be scrubbed prior to sterilization and may have tissue and debris within. Lumened instruments like needles should always be disposed of, not reused. I throw all my FUE punches away for the same reason.

Bill, I viewed the links and had read them before. The only novel device that address the three main detrimental forces are the Feller Punches. The only unique technique to address the Traction force and Compression force is my Perforation Technique. And even with that said, neither has succeeded in overcoming the detrimental forces. They have helped, but not to the point where FUE could now be seen as a substitute for FUT. The other "advances" just make the job easier and faster for the doctor at the expense of donor area. No diminution in any of the three detrimental forces is embodied in any of the other inventions. Also, most of these "technologies" are ten years old already. Nothing new. So what is new to the FUE megasessionist today that didn't exist ten years ago? NOTHING. When you are evaluating a technology just ask if it decreases any of the three detrimental forces. If it doesn't, then it is contributing very little to the advancement of the FUE field. But the invention that ultimately does significantly diminish any or all of the three forces will be worth millions. Perhaps billions. But to date none exist and no FUE instrument billionaires.

Wouldn't that be nice ! Do that and you are an instant multi-millionaire! Dr. Rassman came up with the "FOX test" wherein he picks a random area to extract from and gauges the difficulty or success of the extraction. Problem with it is that one or even five random areas may not be representative of all the grafts. So to me it serves no purpose. I've had plenty of patients who would have failed a FOX test but went on to have excellent FUE procedures and result. Conversely, I've had FOX positive guys who had terrible FUE procedures that had to be stopped. By the way, to get as close to what you asked as I can I do test runs on my patients scalp during the procedure. If at anytime I feel the success to failure ratio is lower than 70% I stop the case. That is also in my informed consent form that the patient reads, acknowledges, and signs before we do a procedure. If we are going to take a risk, I want the patient to KNOW what's going on and what we will do if things are going south. Problem with many FUE only doctors is they don't want to give up the case so they push through it anyway with Success to Failure ratios of even lower than 70%.

Adonix, That patient of mine from five years ago is exactly the reason why I identified and try to minimize the three detrimental forces of FUE. Look at the post op photo of that case. Absolutely beautiful. Looks no different than my typical dense FUT cases. But the growth was easily only about 50%. Why? I removed the grafts with the greatest of care. By 2010 I already had 9 years of FUE experience under my belt. I had even created my own tools and protocols and was included in Unger/Shaprio's HT text specifically for FUE. I showed Dr. Unger himself how to remove his first FUE. I had given lectures and demonstrations at ISHRS meetings and for other doctors in my clinic and theirs. By all accounts I knew what I was doing. So why the poor results? The answer had to be damage during the extractions themselves OR his particular physiology. The so-called "X" factor. Assuming it was somehow my fault I just offered him another surgery for free to fill it in and thicken it up. He accepted. But this time I decided to use a larger punch. I think I went from a .9mm punch to 1.0mm punch. Or, I decided not to do any trimming of the grafts once removed from the donor area as I usually did. Or maybe both. I'm not sure because it was five years ago, but the idea was to not do the exact same thing I had during the first surgery. If you read the link to the website he even mentions my change of strategy for him. And even after a second beautiful procedure his results still weren't on par with FUT. But, he was sure the second procedure grew better than the first. So that helped to confirm that indeed the FUE was too harsh on the grafts causing a lower yield. Less trauma on the grafts during round two and thus better yield. I never did see the final results of the second surgery-but obviously he still wasn't happy. By then he wanted to try his luck with another surgeon, and I don't blame him. Unfortunately, he only posted as far as 4 months after his surgery with my friend Dr. Rahal- who himself did his first FUE in my office. Then the patient stopped posting. So perhaps he finally grew well and moved on; or, his results were no better than mine and he just gave up. I should think, however, that he would have posted a triumphant conclusion if that was the case. But I don't know. Throughout this whole situation I couldn't help but thinking that if he had FUT he would have been "one and done". Also though, could another FUE doctor do a better job than I? If so, how? What could I have done differently. I honestly could not say. But I know for a fact that nobody else could do anything differently either. Not then and not now. And that is part of the point I am trying to make in these FUE posts. If someone claims they can do a better job than I did on this patient through the use of better instruments or technique then it is their obligation to prove how and with what. But to date nobody has. To improve his yield on the second round I reduced the detrimental FUE forces by increasing the size of the punch, leaving more bulk around the grafts, and slowing down the extraction process considerably. And it worked. So how in the world can the FUE-only megasessionist do better by decreasing the size of the punch, stripping the bulk away down to skeletonization, and speeding up the extraction process? The answer is, they can't. Luckily, SOME patients have very tolerant grafts and fortunately there are some very dedicated and skilled FUE practitioners out there. When those two combine you get some VERY impressive results. But no matter how good or bad those FUE results are, for the reasons stated above, FUT would have looked better and with far less risk. But MOST FUE practitioners are not that dedicated nor gifted. Instead, they will sacrifice their patient's donor area by 50% to get enough grafts out to complete the case. The patient of course would have absolutely no idea how much of their donor area was sacrificed. But I do, because I've seen these patients in my office. They may have been given a thousand grafts, but the entire donor area had been extracted from leaving a fibrotic mess. It is the "success to failure" ratio that counts. Am I the only doctor on here with FUE patients that have grown poorly? I think not. There are some doctors very very close to this thread who have more than one RECENT patient right now showing their poor FUE results and sharing their disappointment. Difference is, I don't claim FUE has been perfected and that therefore failure was due to the stars or that it was the patient's physiology that was at fault. I am one of the only capable and experienced FUE doctors to admit openly that there are basic detriments inherent to the procedure of FUE and therefore should not be offered as a substitute for strip. I am also a capable and experienced FUT surgeon so I am not dependent on a single modality for my livelihood and can be more transparent than those who do rely on just one modality. Look at that patient you posted of mine and ask yourself if this result is exclusive to Dr. Feller or to all FUE practitioners. __________________ Feller Medical, PC Great Neck, NY Dr. Alan Feller is a member of the Coalition of Independent Hair Restoration Physicians Providing FUT, FUE, and mFUE

Repeat

Dr. Bhatti, I gave you several chances to engage me in debate and you refused to do so. You quit. I'm a "stone" remember? So instead of trying to engage me to win points in a contest you started but refused to finish, why don't you spend at least some of your online time addressing the viewers and posters of this site? I am not the only person reading this thread as evidenced by the 1000 or more hits it is getting every DAY. Several very vehement FUE only posters have changed their position since the start of this thread. Perhaps your views are beginning to soften as well.

Mick, I think it's fair to claim that FUE appears to be more popular outside of the United States. But I think it only appears that way. If you look at the number of FUE only clinics and compare to either FUT only clinics or FUT/FUE clinics you will see there are very few more now than there were five years ago. I would venture to say no more than a dozen. If you look at the ISHRS listing of doctors the number European and Asian clinics in total exceed this number by orders of magnitude. So who is performing all this demographic changing FUE? Unless we believe that all the FUT clinics and the few FUE/FUT clinics have stopped working for the past five years we can not conclude that FUE has even matched, much less exceeded FUT or FUT/FUE. In the United States there are only three stand alone FUE only clinics that I am aware of. There may be a few more, but they are not established players. But even if they were the number of patients they would be doing still couldn't compete with the number being turned out by established FUT clinics across America. The reason is obvious. FUE is simply not as reliable or as good as FUT due to inherent trauma associated with the FUE procedure as I have exhaustively outlined on this thread alone. Laymen want what they want. Who doesn't want a cut-free or scar-free surgery? I know I would. But FUE is not either of these things despite the blatant innuendo and often time outright lie that it is. It is also not more "advanced" than FUT simply because it came out later in time. It is an ALTERNATIVE to FUT, not a substitute. And this alternative has additional risks and consequences that patients need to know about. Not only should it's drawbacks be clearly outlined in black and white before procedures, but also needs to be accepted and understood within the online HT culture. To date, the culture is hostile and intolerant of being told the realities of FUE. But slowly but surly people are becoming convinced and are starting to question their original belief about what FUE and FUT are. That's the point of this chat site. If it were all agreement and high fives, what would be the point?

Yes. You got it ! You don't see my FUE results online because they are not megasessions and not as interesting to look at or report on. Successful strip cases are much more satisfying to post, but people have grown bored with seeing FUT results. Like I wrote in the first post of this thread: FUT doctors make getting good results seem as exciting as a trip to Pittsburgh. After all, how many before/after pictures can you look at before they all begin to look the same?! 17 years ago ultra refined dense pack procedures were new. They were the excitement of the day, and thus the procedure became standard. The same is not happening with FUE after 14 years. Most of my FUE procedures are filler or repair work, like the one I did this past Tuesday. But if you could go back ten years you would have seen about 50 of my patients online at any one given time. Large cases, too. Lots of FUE and FUT momentum. But I learned that FUE just did not fare as well as FUT patients in the end. So I decided that if a patient was a candidate for an FUT case when large numbers were concerned, then that's really what he should have. I'm glad you're seeing the real story now and did it through your own research. The truth is, the difference between FUE and FUT is even greater than what you have found or could find online. Thank you very much for taking the time and participating. It counts very much.

Mav, I already answered this question, but I'll do so again. The issue of so-called "crown stretching" is a non-existent phenomenon. It was a distraction invented by Dr. Bhatti to find something, anything, to throw at FUT to discredit it on this thread. Have you ever seen any posts online of patients discussing this or even complaining about it? None. I've never had a patient of mine nor anybody else's come to my office and complain of "crown stretch". And the reasons are obvious. Let's say Dr. Bhatti's numbers are correct (although I have no idea where he got them from). Then you are looking at about a 5mm "stretch" in the skin from the donor scar all the way up to the crown. This 5mm will be distributed throughout the scalp and not result in 5 mm of displacement several inches away. Dr. Bhatti's diagram was incorrect and disingenuous because he treated the donor in his diagram like a bed sheet. A one inch pull on one end results in a one inch pull on the other end. The difference is, the skin is attached to the skull all along its length and it stretches so pulling on one end does not easily translate to the other end. Think of a rubber band bonded to the surface of a table at several points. Then pull on one end. See how well it translates to the other. Not well, thankfully. Another disingenuous thing about his diagram is that in the "after" diagram there is no hair on the patient. The whole idea of the surgery was to put hair on the top of the head and it is in absence in his after diagram. So let's say the guy is a stage 7 as depicted in the diagram. Do you think it matters if he has an extra 5mm of crown from stretch (if that's really happening) if the front half of his head went from cue ball to puffy hair? Of course not. Again, Dr. Bhatti just put this out there to present some sort of equivalence in detriment between FUT and FUE and avoid answering my questions. Did he really stop performing FUT due to this heretofore unheard of complaint or phenomenon? Was the dreaded "crown stretch" something he discussed with his patients during his past life as an eeeevil FUT surgeon and included in his informed consent? I highly doubt it. Or did he just invent it for the purposes of this thread? He was trying to find an equivalent negative in FUT to compare with the very real detriments of FUE that I have been discussing in great detail and without any substantive opposition on his part. And he failed because the three detrimental forces of FUE are real and I have been describing and discussing them for 14 years. They also explain the very real complaints by very real patients online as to why most FUE results are inferior to their equivalent FUT counterparts. The only stretching going on here is with the truth.

I am in both camps. And I have performed many FUT procedures on patients who have had FUE prior. Here are my observations: If the patient had FUE in the first surgery, particularly greater than 500-700 FUE, then the implications for a second via FUT are decreased yield. This would be due not only to absence of the follicles that were obviously extracted in the first surgery, but also to the fibrosis and shock loss of the hairs BETWEEN those original FUE extraction sites due to FUE trauma. Many of the remaining hairs would also be partially traumatized decreasing their chance of surviving an FUT procedure. It would be harder to numb the skin and the bleeding would be greater. This is because along with fibrosis comes an over compensation on the part of the body by increasing the amount of blood vessels and nerves in the damaged skin of the donor area. It would be harder to dissect under the microscope because the ubiquitous fibrosis will have infiltrated the entire strip disrupting the normally parallel orientation of the follicles. Also, the resistance of the skin will now be more variable making it yet again more difficult to cut as the blade may now shoot through the tissue instead of a slow and controlled glide. Finally, there will be more postoperative pain as those extra nerve ending fire. I've seen all of this many many times and have read the accounts of other patients who have also reported all of this online. I remember speaking with Dr. Hasson about this years ago and his words were "FUE destroys the donor area. Absolutely destroys it and makes a mess". I can confirm that observation word for word.

Wow! Another one.

Thank you. I have heard this from several other posters as well. You now know the purpose of my FUE posts.

Probably the weakest point of the so called FUE "fall back" is that MOST people simply don't look good with their head shaved. Very very few people who visit my practice can pull it off. Thanks for the participation Fortune, you make very valid points and good observations. We need more thinkers like yourself.

No, I don't think this site is unethical. Nor do I think it's unethical for a licensed physician to practice megasession FUE. It only becomes an issue of ethics if the FUE megasessionist does not provide their potential patient with all the facts so as to be providing Informed Consent. That burden falls to the doctors themselves, not this site. Despite how my critics repeatedly and falsely claim I am anti-FUE, I am not. It has it's place. As such there should be a pool of screened practitioners of FUE just as there is for FUT. From there people can look at the work these practitioners post and then decide who they may want to explore further for their FUE. I

How? Where? Absolutely nothing has progressed since the introduction of FUE in 2001. That's the point behind the debate. This claim has been made since 2001, but there have been no developments. That's why Dr. Bhatti has not been able to name any; and Dr. Vories could only point to an implanter pen- which has no bearing on extraction. The reason you see "so many"FUE results out there is because more and more doctors are willing to "brute force" their way through them. The more people doing it, the more results out there. But what you don't see because you are not a practitioner that I do is the consistently poor results of FUE procedures compared to the equivalent FUT procedure. The wild claims that these clinics are doing something different is completely false. Demonstrably false. Wishful thinking, fantasy. You all are simply looking through the narrow window of internet websites like this. A site where opposition to FUE is met with vicious attack while even the mildest FUE result is applauded. There are MANY poor FUE results on this site right now, yet they are never mentioned. No doctor, including Dr. Bhatti has come on here and demonstrated that he is capable of doing ANYTHING differently than the FUE megasessionist of 14 years ago. And I KNOW he can't. So what "advances" ??? None. But FUE sycophants are not interested in the plain truth. FUE is like a religion or cult for many FUE advocates on this site. Just read what some of these adherents write. They expose themselves with each barb they throw. Mindless hate, petty attacks, and complete intolerance for non-believers. But I will continue telling the truth about FUE and making my case logically. Not for the sake of the "believers" nothing will sway them, but for the legion of people out there reading this thread who truly want to know what the pros and cons of any HT procedure are. This site is in sore need of "equal time".

wow !