Dr. Alan Feller

Gas, It's very simple. I asked you for your phone number three times and three times you didn't send it. And that was starting back on May 20th. You also disappeared but now say that you were away on business ? Your smart phone had no internet connection ? No computers available ? And even if so you couldn't drop me a PM saying you were going away ? Everything you did involved delays and conditions. You were just playing games and wasting my time. And even if I did get you on the phone you set conditions that you knew would have prevented me from posting the call online if it didn't go your way. And you repeated them over and over. If I agreed to those terms there would have been no point in doing the interview in the first place. All you had to do was send your name and phone number in that first PM. I knew when you didn't that you weren't going to. When you finally felt the pressure to actually do it, you leaned on ridiculous conditions that any reasonable person wouldn't agree to and STILL didn't give me your phone number. So I contacted the doctors myself and am waiting for their response. So don't try to flip the script here and pretend that I just blew you off. You played games and I had enough of them.

This question is at the crux of the entire FUE controversy.

Tried posting response again to Dr. L, but caught in filter again. Dave can you discard the first filtered draft and just post the second one ? Thank you, Dr. Alan Feller

Dr. L, I appreciate you joining me on this thread and this topic. I truly do. Even if we don't agree or find common ground it is beneficial to everybody to have this discussion in the open. I read your post very carefully a few times and have to say with respect that you haven't written anything new nor anything I have responded to in the past. I have heard these same things stated by different FUE doctors for 17 years now. Before I start I want to ask if you classify yourself as an FUE-only clinic or as an FUT/FUE clinic ? That is, are you performing FUT regularly ? I want to thank you very much for acknowledging the three detrimental forces of FUE. In 2002 these forces were not known by the names I've given them but they were acknowledged and addressed by several doctors seeking to overcome them. Then, around 2009 doctors began to deny and seemingly ignore their existence or only referenced them as mere footnotes not worthy of attention. See my thread with Dr. Bhatti. The following quote is where our differences begin: "However, I do not agree that these forces cannot be overcome nor should they automatically be expected to lead to a subpar result when compared to an equal size strip surgery." I never claimed that the detrimental forces couldn't be overcome. I believe they can. What I said is that they haven't been overcome. And they won't be for the foreseeable future. The very best way to perform an FUE is the very way you describe that you do it in your own clinic: a manual punch for scoring with meticulous and patient delivery (extraction) techniques. Where we differ in this quote is that detrimental forces of FUE should most certainly and automatically be expected to lead to subpar results just based on the common sense alone that you yourself acknowledged in your post. But if that's not enough let's turn to the textbook: Hair Transplantation 4th Edition, U.nger/Shapiro. In Chapter 9 page 261 an entire chapter is dedicated to "Graft Survival, Growth, and Healing Studies" where the delicate nature of the graft is described as well as the importance of careful handling. And again, on page 355 an entire section entitled "Classic Microscope Dissection of Follicular Units" was written by my friend and mentor the late great David Seager who despised FUE. The very first line of the section reads "Follicular unit micrografts are so small and fragile that the aid of microscopes for their dissection from donor hair into micrografts is mandatory to obtain optimal yield, particularly when mniigrafts are used exclusively and in large numbers". If grafts are in danger under the most controlled and ideal circumstances of FUT dissection, can't you just see how much more in danger must they be in during FUE where every cut is blind and the tissue is grabbed and ripped out of the skin ? Careful and delicate graft handling has been hair transplantation orthodoxy since the rise of the HT industry in the early nineties. Indeed it was a law that grafts must be handled with EXTREME consciousness and care for an HT to have the highest yields. Countless articles were published and many lectures given over the years on the best way to handle grafts-but ALWAYS cautiously. And then all of this was just thrown out the window by the FUE practitioners who squeeze, rip, and tear grafts free from the skin. So not only should a subpar result be expected it is easily predictable when you compare it to the equivalent FUT graft. There is no way around it and there are no exceptions. But if that's not enough let's look at the Beehner study and the Wesley Study where they found individually that only about 70% of FUE grafts survive. And let's not forget the original FUE study called the Fox test study by Rassman and Bernstein. This study didn't even take into account the viability of those grafts that came out because certainly a percentage of those grafts were damaged on the way out even if it wasn't visible. "Torsion - This is the reference to how follicular units are subject to the torsional forces of rotation as the punch presses through the skin in order to free the follicular unit from the scalp. I believe that this is a problem mainly with the continuous rotation FUE tools on the market. With an oscillating rotation driven by the thumb and forefinger, torsion is not an issue if the rotational distance traveled is short and performed with an experienced hand. Torsion still exists, but it is greatly reduced in it’s severity thus having an equally reduced degree of trauma. " This is incorrect. Torsion has been a problem since the introduction of FUE- long before rotary tools were invented for FUE. I absolutely agree however that the use of rotary machines has markedly increased the degree of damage due to torsion. No doubt. But even with a manual punch there is a significant amount of damage being done. If I have you sit in a stationary chair and clamp your pelvis down to it so that it couldn't move then start twisting your body 90 degrees from your shoulders downward the force of torsion in the last third of your body above the pelvis would be enough to snap your spine. This is what happens during FUE but you don't always see it because the dermis is flexible and rubber like and will snap back SEEMINGLY unharmed. Try it with a piece of spaghetti. Hold the bottom and twist the top 90 degrees on it's long axis. It will just snap. It is this torsion force transmitted from the top down that causes the decapitation of the graft. The harder the skin, the worse the torsion damage will be. That's why second FUE surgeries are so much more difficult than the first on average. "When I extract each graft after I score, I use reverse traction by holding the top of the graft at the very upper edge of the tissue thereby avoiding most of the follicle. This is safe to do because we all know that the follicle, even slightly below the epidermis can be safely cut through and regrow without permanent damage, as is seen in trichophytic closures in strip surgery that have been performed for the past decade." I do agree that the graft is safer if gripped from above for the reasons you mentioned. Absolutely. But FUE grafts are not removed with just one grasp of the forcepts. To do so would put incredible traction on the graft along it's entire length for absolutely no reason. When you pull something up on a rope do you yank it up as far as your arm can go, or do you slowly pull the load up in a hand over hand fashion under controlled circumstances thereby distributing the force over the entire length as much as possible? I'm sure you are not saying you just grab the graft at the top and rip it out. It looks like, from your video, you are using the hand over hand technique that every manual FUE doctor uses. In the two forcepts method the top is grabbed and traction is applied, but then a hand over hand method using the forcepts is employed to work your way down. You must necessarily squeeze hard to be able to grip the graft with enough force so that it won't slip free when traction is applied. There is no way around it. Years ago Dr. C of Atlanta invented a device that leaves a space in the forcepts for the graft when squeezed to minimize compression but I didn't think it could work and sure enough I don't think he uses it and I've never seen it on the market. Compression and traction go hand in hand. No way to separate them. Now compare this to FUT where there is no compression force at all because there is no traction force at all. "Traction - This has perhaps the highest chance of causing real damage to the follicular unit but with practice and experience it is not an issue of debilitating circumstance. The bulbs are usually intact as long as the arrector pili muscles have been cleanly severed (best with a very sharp punch) and they come out fairly easily. This is of course not always the case but a proper surgeon will take their time at the beginning of the procedure to properly assess the patient, their grafts, the supporting tissue, and how it all works together. In most cases, the patient is a candidate with very few limiting factors." Traction damage is not a function of practice and experience. It exists independent of it. Sure, a beginner who yanks the graft out at odd angles can learn to control what they are doing and improve, but even the most experience doctor is not going to be able to tear a graft free without cost. If you view the video Dr. Bloxham and I made called "plastic surgery" we show with a piece of plastic what is happening at the level of the bullb, and it is very disturbing. Bulbs and dermis may look like separate entities, but in reality they are not. Dermis is like tape and the follicle is like a noodle that is attached to the tape. When you tear the noodle from the tape serious damage occurs. Now think of taking a bandaid off your skin. The skin and the bandaid really are separate entities but we all know how much that hurts. It's orders of magnitude worse for FUE grafts which have no epidermis to protect it at the level of the bulb. It's twisting, squeezing, and pulling an eyeball. How well will it work after a forcepts has finished doing that to a human eye ? The problem with assessing a patient at the beginning of a procedure is that once you move a half a centimeter away you may be dealing with a completely different set of physiological circumstances. That was the one problem with the Fox Test in my opinion. And while grafts may release SEEMINGLY easy, it doesn't mean that those grafts haven't been harmed in the process. I believe fewer than 15% of patients are in the "easy" extraction category according to the Rassman Bernstein study which is seminal and is as valid today as the day it was published. " Skeletonization is one stated side effect of traction but I believe that this is no different than the skelontization that occurs from subdividing follicular units (turning multi-hair grafts into singles and doubles) during strip surgery. It is well known in the community that this is routine procedure for some strip clinics, and the pros and cons of such procedures have been debated before, in forums and in the ISHRS." This is just not true. And I must vehemently oppose your quote. In fact, it is a fantastic statement that I have never heard from any HT practitioner in the past- doctor or technician. Skeletonization is unique to FUE, and the way it is produced is exclusive to FUE. There is no process in FUT that leads to skeletonization and no analogue. FUE owns skeletonization lock, stock and barrel and it is by far the most obvious disadvantage of FUE when compared to FUT. While the pros and cons of dividing FUT grafts down from 3-4 to 1-2 may be debatable, it lends no support to the claim that it causes anything like the damage caused by FUE in the production of a skeletonized graft. I, the case of FUE the graft was blindly scored and then blindly ripped out with great force. In FUT the grafts are split from the side on a solid surface, in full view, under a microscope, with ideal lighting. No comparison. (By the way, I am against splitting down FUT's into 1-2 hair grafts unless I absolutely have to which is maybe one to times per year). I will address the rest of your post but will have to do so in another posting. Thank you for your input and participation.

Just tried to post my response to Dr. L but caught in the filter.

I'm afraid that's not what doctors say behind the scenes. Your doctor included. Should I warn Dr. Lupenzula to remove his thread because, according to you, he should just let his results speak for themselves ?

That's because my question was not an offensive question and, by your own admission, a valid one. Your question about me, however, was offensive. You designed it to cast an aspersion on me. No other reason. You couldn't care less if I'm performing surgery or not. After all, you said you wouldn't come to me. So why should you care ? You don't. You wrote a statement in the form of a question to get away with malice. Nothing more. This is why doctors will not come onto chat forums and interact. I know this for a fact because I speak with them behind the scenes. And who loses ? Everyone.

"Please correct me if I'm wrong but does HairDew get paid by an FUE clinic to disparage FUT doctors in public forums ?" Get my point ?

This was a low blow and uncalled for. Of course I still perform surgery. I never stopped. If you genuinely wanted to know something about me, why not just call or visit my office? Why the need to cast aspersions on an open forum ? Wasn't too long ago you were singing my praises on this very site and had me at the top of your short list. Now my work isn't good enough for you ? Guess I had better sharpen my skills. By the way, it is posts just like this that explain why doctors will not participate on chat forums. Congratulations.

Thank you for your honesty. You are in VERY good company. The real reason FUE holds any appeal to the masses is that when visualizing the actual act of the surgery it SEEMS less drastic than it's FUT counterpart. To some that's all it takes to opt for it EVEN IF they are made aware that the consequence of the procedure are poorer growth, poorer results, and greater donor damage. mFUE addresses the TRUE issue by minimizing the envisioned act of the surgery yet preserving the growth yield. It's a middle ground that got overlooked about 17 years ago which was the logical time it should have been realized. Better late than never.

Hair is important, but it is not the end all. I have had patients visit with obvious issues in their lives and in some cases they believed a hair transplant would address not only their hair loss but these other issues as well. To some hair loss is an obsession or at the very least extremely "mind consuming". This video puts all that into perspective in a very articulate and interesting way. Dr. Alan Feller

Don't know how to make it any clearer for you. On June 10 you posted claims about me which are demonstrably and undeniably untrue. What you "believe" is immaterial.

You're concerned about a scar that is easily concealed under a short length of hair but not: 1. The lower growth yield of FUE ? 2. The poorer results of FUE ? 3. The increased donor damage FUE megasessions inflict limiting future yields? 4. The thinning of the donor area due exclusively to FUE We will be releasing our mFUE results in due time. FUE only clinics have much to worry about because despite untrue and misleading claims on the internet MOST patients have no problem with a scar that is easily hidden by short hair. It is the fear of the surgical strip harvest itself. They only claim they object to the scar so as not to admit their true fear. This is not supposition on my part, it's based on real world patient consultations. Most patients admit to me that they can't stand the thought of a strip being removed from their head- not fear of an easily concealable scar.. And, MOST patients who visit seeking FUE switch to FUT when they are given the reality of both procedures. Those who can't be comforted enough to accept FUT readily accept mFUE as the alternative. With the choice of FUT or mFUE there is almost no point in performing FUE which is inferior in growth yield to the other two. And growth yield is the primary factor in hair transplantation.

Actually, hair loss suffers have not spoken. If you watched my Myth video you would know that. FUE is not gaining in popularity. It is only gaining in hype, as it has been for over ten years. The mFUE procedure is not as good as FUT, but far closer to it than FUE. Substantively, mFUE causes less damage to the grafts during extraction and damages the donor area less than FUE. It also results in less donor thinning for which FUE is notorious. A recent analysis and article by Dr. Paul Rose of Florida supports this. It is also becoming common knowledge that donor thinning after megasession FUE is a regular problem. Patients who are looking into FUE are doing so because the truth of the dangers of the procedure have been downplayed, hidden, or outright lied about. Mostly by anonymous online posters. If, however, a patient opts for a megasession FUE and is given informed consent in writing as to the disadvantages of FUE compared to FUT I have no problem with it all. Buyer beware. When a doctor offers megasession FUE without first offering the patient FUT and explaining, in writing, the disadvantages of FUE, he is doing a bad thing. Thank you for viewing and posting my video.

So from your response in post # 175 you are not going to stop posting false claims in public about me which include your active assertion that I engage in deceptive practices. You’ve got the situation completely backwards: I have no duty to perform in order to clear my name of the defamatory statements and accusations you made about me in this public forum (all of which I completely and easily deny by the way). Rather, it is your legal obligation to be able to support every last nasty and defamatory word you used in your malicious and uncalled for post of June 10, 2017 Post # 171 and others. Something I know for a fact you cannot do. I can assure you, this is not a game and that I do not bluff.

mav23100gunther, Are you sure you want to continue accusing me of engaging in a "bluff" in a public forum ?

0:44 - "FUT tends to be for more advanced hair loss ". Correct.

Justin, Your description is the classic beginning of the FUE cautionary tail. The short answer is no, FUE is NOT a good option for you. Let me tell you why: 1. 1,000 to 1,500 grafts is not a small procedure. 2. You should not have a hair transplant with the expectation of being able to shave your donor area. 3. Your estimate of less than 10% sacrifice is wishful thinking. But not your fault, you have been lead to that false conclusion by the internet and silence of FUE practitioners who should be disclosing more. This is called "informed consent". 25% sacrifice of grafts during FUE is a more likely optimistic figure. From there the success yield goes DOWN. Compare this to FUT which is about 2% and UNDER ! 4. Your understanding of a "top rated" surgeon is also in error. There is no such thing as a "top rated" anything regarding FUE. There is a lot of unsupported internet hype, self promotion, and a willingness to let the public draw it's own conclusions but that's about it. The limitations of the FUE procedure are independent of the surgeon performing it. That has been the basis of my opposition against large FUE surgeries for the past 15 years. By the way, I may know who you mean by "top rated" and they don't perform their own procedures, their technicians do it in violation of basic ethical standards. If those doctors did that in the United States they would lose their licenses. There is a reason for this and you and other potential patients should not ignore this. Too many have to their detriment. If you need 1500 grafts now, chances are you will need more in the future. You don't want to sacrifice any of your donor area for the immediate satisfaction. Instead, get a proper FUT and ask the doctor to locate the donor zone high up in the donor area. This way you can do a fade cut. This method has been working wonderfully with military and police patients for over 20 years. This way when you need more, the rest of your donor area is virgin and ready to give it.

Here is a physiological explanation as to why you should not get an FUE megasession: This video is almost two years old and not a single FUE megasession doctor has addressed it nor refuted it. And the reason is simple: they can't refute it. To you potential patients out there wondering if you should have FUT or FUE rest assured that you want FUT.

Yes, it overwhelmingly recovers- in FUT. But you are a hybrid, aren't you ? You had two failed FUE procedures and then an FUT to repair them. So the question is: how will a person who has FUT AFTER failed FUE recover ? It depends on the amount of damage from the FUE extractions and how well your body was able to compensate for it prior to your FUT procedure. The reason is germane to this topic. In a typical FUT case there is blood vessel disruption in one particular and confined area, the area where the donor strip was taken. As a result you may see shock loss from that area extending away. Usually from the scar downward. But, since the vascular disruption is in such a thin line and most of the affected skin has not been touched by surgery the body will usually compensate and heal it rather quickly bringing the shock loss areas "back online" with no problem and little permanent hair loss. Not so with FUE. FUE causes direct damage to the donor area. Guaranteed and with no exceptions. And the damage not only affects the skin where each and every extraction is pulled from, but skin further down the "vascular line" that is depending on that blood for survival-even if that area had no FUE extractions. Indeed, FUE causes 13 TIMES the amount of vascular trauma, and the consistently thinned appearance of megasession donor areas bears this reality out. The physiologically costly difference between an FUE and an FUT is that in an FUT the wound is stitched closed. Vascular bridges are very quickly established over the gap because both ends are now in contact with each other and nature takes it's course. FUE is the opposite. In an FUE case the holes are left open. The ends are not brought together. They can't be. So when you add up the gaps in total you realize you've left a gapping hole in the scalp which blocks vascular recovery. The laymen looks at an FUE donor area and just sees a bunch of small holes and thinks no big deal. A knowledgable doctor looks at it and sees serious vascular damage. Similar to shrapnel from a bomb or shot from a shotgun. Several of my colleagues have claimed that the holes are so small and so shallow they have no vascular consequence. Really ? I say. Then why do they need to sponge up and irrigate blood away continuously throughout the extraction process ? Below I will post a video I did to explain why an FUE victim was suffering so much after his FUE procedure. He had just had an FUE megasession and was in pain and suffering from an apparent infection. He reached out on this forum for help because his doctor was not available. This video explains the chronic vascular deficiencies suffered by FUE megasession patients as well as associated painful chronic FUE neuropathies, and massive FUE donor thinning.

You got it. Quite a few parallels on this site.

Yep, that's it ! It's my "aggressive" behavior ! Are your feelings hurt ? Well, I'm truly sorry for that. Truly. But facts don't care about feelings. And it's my job to deliver the facts until someone can show me new facts. So far, nobody has. Can you believe that ? Ahem. By the way, you are on my thread. You chose to come onto it. Notice no FUE practitioner has come on here to refute the interview I posted with Dr. Reed ? Nor the interview with Dr. Lam in another thread? Nor any of the FUE videos I've posted ? Nor anything else I've ever written about FUE for the past 15 years? Look how many views this thread has. You don't think FUE doctors aren't following this thread ? You bet your hair follicles they are.

That's my point. If grafts are knowingly wasted, they are wasted. Doesn't matter what the INTENT is. The question is: what's the difference between wasting them by throwing them in the garbage or by killing them during the extraction process? None, of course! Putting a different label on what caused the waste of grafts is immaterial to the patient. FUE = Graft waste. Or to put the formula in your terms: FUE= Throwing Grafts Away You are uninformed and your posts are misleading. I do not mean this as a swipe, it's just the truth. I would ignore your posts but for the fact that they confuse the public who actually believe that you have a clue as to what you are writing about. My colleagues should also be chiming in, but to their shame and negligence they don't. You have: Never performed a surgery. Never seen one performed. Probably never even met a person on whom a procedure was performed, Have no medical training. Have no actual medical experience. Have no intimate knowledge of what's going on. The sum and substance of your knowledge is a lay internet chat forum and what other lay posters write. Period. You believe you are debating me. I don't debate laymen. I debate colleagues ALL of which have failed to come onto this site to "set me straight" except for one who got his butt kicked and fled the debate based on his OWN video of how he performs the procedure. Now why do you think that is my friend ? I perform both procedures, and even a third, and can tell you with force that FUE is a bad idea for a megassion if you have the choice to have an FUT. But I'm not a regulator or a hair transplant cop. Do as you will. All I can do is what I have been doing. The rest is up to you.

You're not getting it: When a doctor performs a megasesson FUE he guarantees the unnecessary wastage of grafts every single time. Not by virtue of "binning" them, but in the very act of extracting them. Not so for FUT. So when a patient opts for FUE he does so at his own risk knowing that he is going to waste grafts as compared to an FUT. But when a doctor offers FUE instead of an FUT without telling the patient he will be needlessly wasting grafts he is demonstrably acting unethically. FUE has grown and thrived on the willful and "pretend" blindness of BOTH parties.