Dr. Alan Feller

Now you get my point totally. We have already been through two "FUE hype" eras. We are now in the third. FUT still rules and will continue to do so until someone comes up with a way to reduce the three detrimental forces associated exclusively with the FUE procedure. To date, nobody has. What's even more amazing is that almost nobody has even tried. I tried, and had some success. But I have yet to see anybody break down the problems as I have and come up with real world solutions that are better than mine. The robots and other semi automated devices are not useful advances. They still subject the grafts to the same detrimental forces, but just do so while making it easier for the practitioners. That is not an advancement for the patient and it just serves to hike the price needlessly. Over 16,000 hits on this thread and not a SINGLE FUE doctor chiming in to "set the record straight". Telling, isn't it? But I have gotten feedback from other honorable and transparent FUE doctors and the responses are not going to make the FUE advocates on this thread, or any other, smile very much. More to come. Dr. Alan Feller Feller Medical, PC

Receeding, I want to correct you with respect to cherry picking grafts during FUE. You wrote it was of course true. In fact it isn't true. FUE is a blind procedure. We have no idea how many follicles are under the skin in a follicular unit until it is actually extracted. It is only during FUT that grafts of any kind can actually be cherry picked. Dr. Feller Great Neck, NY

Well done Mav. Well done, except for the false notion as presented in the quote that obtaining single hair follicular units via FUT involves or requires cutting down doubles and triples. This is simply not true, and in fact it is FUE clinics that cut down double and triple hair FUEs to obtain enough singles for hairline work. Most FUT procedures produce about 20% singles which in a 2500 graft case would yield about 500 singles, which is usually enough to build a new hairline on the average head. One of the biggest FUE myths is "cherry picking" grafts. Unless you have X-ray vision you cannot cherry pick grafts during FUE because there is no way to know before you extract a target graft if there is one, two, or three hairs in it. Often times what appear to be a single hair FUE may actually be a double with one hair in telogen (sleeping mode). This is a real problem for FUE. Not so for FUT where the follicles can be seen easily under the microscope.

Mav, Before I respond I would like you to read it yourself a few times and then tell us if you see any issue with what was written at all. You have educated yourself online for some time and have already had one HT procedure. In your experience is there anything worth mentioning that you can think of based solely on the content of those two paragraphs that you posted? Does anyone else have anything to say concerning these two paragraphs? I await and look forward to your considered response. Thanks, Dr. Feller

I'm sorry Voxman, this thread is not just about me, my practice, or learned beliefs. With over 15,000 hits and hundreds of posts it clearly goes beyond that. It also touches a nerve in every FUE advocate out there. You included. This thread is so active because it makes the claim that "the emperor is not wearing any clothes". And I am quite qualified to make that claim. But that's ok. I've been busy behind the scenes contacting FUE doctors and getting the truth from them in no uncertain terms. I'll publish the results in another thread. You probably aren't going to like the results. This should have been done a long time ago.

If the doctor who did surgery on you did not provide that information then you did not receive informed consent. You had your surgery outside of the US so I don't know what legal impact that has. I also hope you heal and grow well. Update us on this site. Do you have photos to show at this point?

The doctor who was anti-FUT is not recommended here. Enough said about him. As for everyone else you wrote: "Everyone else was confident that fue would deliver an excellent result without a scar and still leave plenty of donor hair for the future. " It's nice that they were "confident" of future results, but that word means nothing legally. Did they inform you in writing of the lower yields produced by FUE along with the greater damage to the donor area? Did they tell you in writing that FUE is considered secondary to Strip surgery?

I should think these doctors would be happy to stand by their recommendations and take the time to educate the public as to their reasoning. In fact, as recommended doctors they are required to do so by agreement. I would like to ask you if when you called all these doctors did you simply describe your hairloss and nothing more and then they recommended FUE over FUT; or, did you lead them and say you wanted an HT but no scar or something like that?

Irish, Couldn't agree more with you that strip is the safest and most reliable for mega sessions. Because it simply is. This is not conjecture or opinion, it just is. The lack of FUE doctor participation is deafening, isn't it? See you in October. Best.

"I consulted with many doctors, some who do both fut and fue, and virtually everyone recommended fue over fut." Wow! Really? Virtually every one?! Could you please list here the names of those doctors? Were any of them recommended by this community? I'd love to know their experience level in both FUT and FUE. And perhaps you could ask them to come onto this topic and join the discussion.

The desire to cut hair short isn't any greater among Hispanics or Blacks than it is among any other ethnicity. But these two races in particular should be VERY leery of FUE procedures due to the very curly hair they both tend to have. Curly hair usually means curved or angled follicles which is not conducive to FUE surgery due to high transection rates and other damage during extraction. As a Hispanic you would do well to fade cut your donor area such that there is just enough hair to cover the scar. This would give you the best chance for growth in the recipient area. Which is, after all, the point of getting an HT in the first place, right? The reason most people may not want FUT initially is not because of the hair styles they desire, but because they fear the procedure itself. After speaking with a well established FUT practitioner with a well established record that fear usually melts away along with the fantasy that FUE is just as good.

Mick50, We can only speculate why other FUE doctors have not come onto this thread to "set the record" straight. It's rather damning, isn't it? And you are also correct that patients who have had failed FUE results most certainly would have a colorable claim against their doctors. The basis for such a lawsuit would be failure to provide and obtain Informed Consent. And I have no doubt with the rise in the number of FUE procedures being performed it is just a matter of time before the first one is brought. I have little doubt it has already been brought but settled quietly as most lawsuits are. Here is a snippet of what I include in my FUE informed consent: 1. FUE technique subjects the target hair follicles to more trauma than they would experience when compared to strip technique. 2. As a result growth yields are consistently lower when compared to strip technique 3. FUE is not scar-free surgery 4. FUE produces considerably more scarring than the standard strip procedure 5. FUE is not designed for patients wishing to completely shave their heads at any time after the procedure. 6. Not all FUE surgical attempts will be successful. 7. Case may be cancelled if doctor feels there are too many damaged FUE grafts. If an FUE doctor is not providing his patient with that list of reality before their procedure they are failing to provide Informed Consent. I get this in writing before every FUE procedure and will not proceed without it. FUE is a great procedure when the patient is carefully selected and fully informed as to their choices. 99% of the time the proper choice is FUT.

I'm sorry FUE2014, FUE is not gaining popularity over FUT. That is an online myth created by wishful thinkers and anonymous online FUE salesmen...several of whom were just busted on this site alone in the past two months. There is more FUE being performed, but not at the expense of FUT, but rather in addition to it. Some doctors who are capable of performing FUT may dabble in FUE, but their practices are still 98% or more FUT. In the United States I can only think of just 3 fulltime FUE-only clinics/doctors. That is up from just 2 from five years ago. Not exactly a spike. As for this site there are only 2 recommended doctors who are FUE-only in the United States, and none of them are Coalition Members. Again, not exactly a spike. If I'm "old fashioned" then I don't hold a candle to those who want "short haircuts" because this style is about as old fashioned as it comes. Just watch any movie from the fifties. We don't base surgical choices on hair styling options. We base them on what will allow us to get as much hair as possible, with as little damage to the body as possible, with the greatest possibility of taking more hair in the future if needed or desired. You have not operated on a person in whom 2,000 FUE grafts were extracted. I have. It is follicular holocaust and leaves the donor area ruined with sheets of fibrosis. But hey, if you want to ignore reality, go right ahead. It's your scalp, not mine.

Too busy to respond? Really? Every single FUE doctor in the world (literally)? They certainly found time to read this topic. Over 15,000 at this point and counting. Try as you may to turn this thread into some sort of personal feud or attack, the objective concerns about FUE I've raised are all too real and need to be addressed publically by those that support this method for mega sessions. If you as a patient or potential patient wish to ignore the facts along with the undeniable reality that the other side won't even respond, then that's your choice. Hey, in the end it's your scalp.

You are being disingenuous, Seth. The skin may feel the same to you, but I am referring to the changes that affect the skin and hair around each of those tiny dots. To the finger you will feel no significant difference, but when you try to extract hairs via FUE or FUT the scarring is massive and will severely limit the number of otherwise obtainable grafts. You are also disingenuous with your description of the dots. Yes, each one is relatively tiny. This is true, but THOUSANDS of them do not make them "near impossible to see". In fact they are quite easy to see. Unless of course you allow your hair to grow out. Then they are nearly impossible to see, but the same exact thing is true of FUT scars. So why risk the lower yield and greater donor damage of FUE ? Ask your doctor about the phenomenon of "Follicular Collapse" during an FUE attempt. Even if he is unaware of the nomenclature, he knows what I'm talking about. It's when you go into a fibrosed area of the donor and attempt to score around a target follicle. But instead of the punch gliding through the skin in a controlled manner, it collapses right to the skull like stepping on to a floor board eaten out by termites leaving a transected/broken graft.

Seth, your skin is anything but the same as it was before. If you've had thousands of FUE attempts performed in your donor area I GUARANTEE you have massive change in the skin as I described above. Shave the area where you had your FUE and take a photo and put it up on this topic. I'll show you with ease where the damage is. FUE is anything but a "scar less" surgery.

It means what I wrote. The more FUE extractions you attempt, the closer and closer the holes get to each other which in turn allows the overlapping of scars from one hole to the next. I call this "confluence of scar". It results in sheets of fibrosis, shock loss, and permanent damage of the scalp. The effect is irreversible. In terms of future HT the impact is devastating. Should a second FUE procedure be performed the skin reverts from soft and flexible to hard and brittle. This in turn reduces the success rate of extraction, a problem that, incredibly, is NEVER discussed or even mentioned. PRP would NOT help. In fact, it would HURT. The use of PRP during an HT procedure is irresponsible and demonstrably bad. I can't believe it is ever done. Using it after the fact to improve a fibrosed donor area (or fibrosed anything) will only make it worse. Guaranteed. Remember when you were a kid and bumped your head hard and a day later you noticed an "egg" in the skin? Well that was a hematoma, a collection of blood in one area trapped under the skin. As the hematoma solidified, thanks to platelets, the skin itself fibrosed. Ultimately other blood factors ate away most of the hardened clot and the "egg" went away, but not without damaging the area from the inside. If you were to stick a needle into it, as I do every day, the skin would be quite hard and brittle. PRP is a hematoma on steroids. It would CAUSE fibrosis on top of an already fibrosed area.

No, i do not believe the tools have improved since the introduction of FUE. In fact the doctor who was the first to sensationalize FUE routinely used .7 mm punches. So no improvement there. I developed and patented some FUE tools that addressed the torsion problem, but even that didn't make a huge difference. It's still selling throughout the world to this day however. I sold the business and patents as it was getting beyond me. But I still use them to this day. No other punch has surpassed it in my opinion and experience. The use of a smaller punch may decrease the area necessary to tear, this is likely true, but the area of follicle available to endure the tension upon traction with forecepts is also decreased, thus a more easily injured and skeletonized graft. Of course compression is also worse when the graft is skinnier as there is less tissue to protect the cells of the follicle. Think grabbing an eyeball directly and then squeezing. That's how grafts should be thought of. So no, Spanker, no improvement in reality. Quite a lot of window dressing, but no substance. Smaller punches are not new. Better to use a larger punch. Or just mFUE.

Voxman, "Scathing attacks?" Please show me where that occurred. I have been personally attacked multiple times on all my topics, but I have not attacked anyone, scathing nor otherwise. "338 posts and still no consensus!" From whom are you seeking consensus ? Uniformed anonymous lay posters who engage in wishful thinking? Where are the FUE doctors??????? Not a peep from them. ***The lack of participation on the part of actual FUE megasessionists is deafening don't you think?**** Think they haven't read this topic with thousands of views and hundreds of posts? You bet they have, and not a single word. How is that for consensus? FUE advocates always try to reframe the debate by claiming there are so many FUE cases out there so therefore FUE is just as good as strip. Nope. Simply not true, and a disingenuous shift of the conversation. So many times the names of FUE doctors are invoked to support the uninformed view of vociferous posters. But those doctors never come online to actually back up these statements. Surely that's been noticed by now? I say again: No matter what result you get from FUE, good or bad, doing the same surgery with Strip would have yielded a better result each and every time. It is up to the FUE megasessionists to PROVE an improvement in the following detrimental forces associated with ALL FUE procedures in order to make the claim that FUE megasessions are as reliable as strip megasessions: 1. Torsion damage 2. Traction damage 3. Compression damage Yet to date not a single FUE doctor has. There have been NO improvements in FUE since it's inception. None. Any allusion to such is nothing more than ignorance and wishful thinking. Or worse: out right fraud. Every time I read about a patient who had a megasession FUE I think of their donor areas being fibrosed and devascularized. An absolute brutal assault on the only scalp that patient is ever going to have. Strip FUT does not suffer from this type of trauma and is why all physicians must describe this reality to patients before offering FUE because not to do is to fail to give informed consent. One lawsuit based on this reality and the party is over. At least in the United States where the law frowns on doctors who fail to properly inform their patients of the main stream methods before offering alternative forms. FUE is an alternative. Simple as that. It has had 14 years to prove itself and still has not. Solve the three detrimental forces of FUE and you will have an HT revolution. But it hasn't happened yet and none of the so called new technologies on the market even come close to it. Perhaps it will happen, but not likely to be soon. The floor for debate has been opened for a long time, problem is the FUE camp never showed up.

"...and see the risks in a FUT far outweigh those in a FUE." AWP, This is simply untrue. But don't take my word for it, contact any of the FUE doctors you consider to be top flight and ask them how growth rates compare between the two. They will all tell you without reservation that FUT is the safer bet. And they better do this as claiming the opposite would be failure to provide informed consent to the patient. A legal no-no in the United States. The linear scar in the back of the head is not an issue unless you shave your head. But if you're going to shave your head, why get an HT in the first place? Simple, grow your hair out to number 4 buzz or greater and the scar is absolutely INVISIBLE. 99% of patients have no intention of shaving their heads. In fact many have gone through that phase and want to get away from it. Perhaps there are FUT doctors who find FUE so burdensome that they advocate for FUT. But I'm not in that camp. I perform FUEs regularly with no problem. The reason I advocate for strip is simply because the chances for a pleasing and cosmetic result are higher, and the chances of damage to large area of donor area is lower. I am an HT patient and know all about FUT and FUE from the inside and I wouldn't have a large FUE session performed on me. Look at what London is going through on this thread. What do you think caused his problem? It was FUE harvesting. The amount of damage is 13 times that of FUT in the donor area. Think about that for a while. And this is not a rare complaint. If he had FUT this would not be an issue. Dr. Feller

For legal reasons I can't advise you on specific treatments. However, I can tell you there is medication that can help you. A typical physician should know which ones. He doesn't need to be a hair doctor. Dr. Feller

Hair-Buyer, If only it was as easy as throwing money at the hair loss problem. It isn't. Unfortunately, paying more doesn't mean you get more. And it certainly doesn't mean you will be walking on the safe side. In fact, body hair transplants are still considered experimental and at best result in only a 1/3 growth yield in almost all patients. If you wish to regain your front and top it must be done at the expense of the back. However, you can minimize that expense by utilizing the strip method over the FUE method for megasessions. Problem with body hair transplants is that many are used in the scalp, and when they fail to grow well they leave crops of scar tissue in the recipient area which damages the skin, gives a shiny and mottled appearance and can cause shock loss. I also happen to feel most BHT look like pubic hair which does not match normal terminal hairs of the scalp. Dr. Feller Great Neck, NY

Options, I don't know where the link is that you are looking for, but I believe I remember it. The thing you are probably concerned about is the side effect of FUE that can be rightfully called: FUE Donor Area Neuralgia. Also known simply as FUE Neuralgia as you almost never see it's counterpart in FUT surgery. This is a condition that occurs after the donor area is harvested with a great number of FUE. It's symptoms are a persistent and deep burning sensation in parts of, or throughout, the donor scalp that is not relieved with pain tablets. This condition can last for weeks, months, or even years. The other concerns you may have read about are: 1. Lower and inconsistent growth yields compared to FUT 2. More damage to the donor area resulting in fewer harvestable grafts in the future if needed 3. Donor area shock loss which appears as a moth eaten look or patches of thinning. FUE is a good procedure for smaller cases. If you need greater than 1000 grafts -now or in the future- you would be better served going with FUT (strip) procedure. Best, Dr. Feller Great Neck, NY

The difference is I'm not advocating the rocks on the moon have any value whereas you are vociferously advocating for FUE based on one study whose very first words include the following: Prepared by Relevant Research, Inc. Chicago, IL, USA Notice: This Practice Census is published by the International Society of Hair Restoration Surgery (ISHRS) and is a compilation of information provided solely by participating physicians. The information published in this survey was developed from actual historical information and does not include any projected information. Neither Relevant Research, Inc. nor ISHRS has verified the accuracy, completeness or suitability of any information provided here, and ISHRS does not recommend, encourage, or endorse any particular use of the information reported in this survey. ISHRS makes no warranty, guarantee or representation whatsoever and assumes no liability or responsibility in connection with the use or misuse of this survey. The Village would be the absolute last place I would go to discuss politics. They are way to intolerant down there. The Italian food is a different story, however.

Ontop, Yes, I have something different: the real world observation that 30% of HTs are NOT FUE . This is not a "hunch", this is a reality that is not available to you because you are not in this business. My patients come from around the world, most foreigners are from the UK by the way. Very few have had FUE, and all was poor work. I am also contacted online daily by patients from around the world and almost NONE of them have had FUE. That is a lot more valid than non verified questionnaires that are sent out to HT doctors from the club known as the ISHRS. I also speak regularly to other HT doctors and they perform either no FUE or very very little. Why? Because strip works better. It is not my job to disprove somebody else's wild claim. It is there job to prove it. If you believe the ISHRS statistic so much, why don't you invest in an FUE clinic. To you it's a sure bet, so put your money where your mouth is and go for it.