Dr. Alan Feller

Mick50, In answer to your questions I will say it again: No matter how good any particular FUE procedure grows, it would have grown better with a strip procedure because the potential for injured and transected grafts is far lower. No matter the size of the FUE case, the equivalent size strip procedure will produce less scar tissue in the donor area. No matter the size of the FUE case, the equivalent size strip procedure will produce less donor damage and diminishment of irreplaceable donor grafts for FUTURE procedures. You have not seen FUE damage first hand and had to operate in it. I have. When these patients gave FUE a try and were devastated by their poor results they realized that their best chance was to go for the gold standard of strip. But by then the donor area was decimated with shock loss and scar tissue. There are many great FUE cases out there. There should be since it's been out there for 14 years. I perform them myself. You make generous mention of the wonderful FUE cases you've seen on this site. But not a word on the failures and unhappy patients who also post on this site. They are here and present, just ignored by the FUE cheerleading squad that resides on this and other sites. The number of FUE cases out there is miniscule compared to successful modern FUT cases. No matter what bluster and supposition you read on chat forums from anonymous posters , FUT (strip) is still king of the HT world. Hands down. No contest. After 14 years FUE has had its chance at parity or domination and has soundly lost. Yes, there are more and more doctors practicing FUE- and therefore patients. This is for several reasons: 1. Catering to the public desire...even if it isn't in their best interest. 2. It is much cheaper, easier, and faster to get into the FUE side of the HT industry. Let me put it this way. When a doctor's secretary says that a patient who had FUT one year ago is coming in, he's unconcerned about the level of growth and the likelihood of patient satisfaction. However, when the patient coming in has had an FUE he is very concerned and curious as to how it grew out and wondering if the patient is happy or unhappy. For the FUE-only clinic, they have no choice because they only had one modality to offer. But the Strip/FUE clinic had two: FUE and the better procedure. If the FUE turned out well he is a hero. If it didn't, he has to live with the fact that he did an FUE when he could have done an FUT which would have significantly increased the chances of success for that first surgery and increased the number of grafts available for a second. Now, let's take this FUE patient. If he were unhappy with his first HT as an FUE, do you really think he will make his second HT an FUE again, if it all? Or would he logically switch to the more reliable strip? And don't you think at that point he wished that he started with an FUT? This is the real world balancing act that is not discussed on these boards that I wish all patients would digest and understand instead of getting lost in wishful thinking and precarious betting with their irreplaceable donor areas.

I usually have my patients wash with shampoo and tap water the very next day. It's not a problem for the grafts. The issue isn't the potential drying out of the grafts, if that were an issue a few sprays per day of saline would not help. The point of spray moistening the scalp post op for the first few days is just to soften the crusts a bit to allow them to come off a bit easier. But it's not necessary. A shower once per day with shampoo will do the same thing and provide the mechanical cleansing necessary to encourage those scabs to come off. By the way, the tops of the grafts are NOT alive. So when it falls off in the form of a crust it is meaningless. The tingling is probably coincidental as stunned nerves are probably waking up and firing. It will usually sort itself out in time.

Hi Sparky, I get where you are coming from by pulling the photos. A donor scar on the lower side of the occipital bump is correctly placed, so don't worry about that. It's when it's WAY below the bump, essentially on the neck that the problems really begin. Most scar revisions (the process where it is cut out and pulled together again and stitched) rarely works out well so I wouldn't be to disappointed with yourself opting for FUE into scar. Problem with scar is that it is poorly vascularized and so FUE grafts, or any grafts for that matter, tend not to grow well. You may want to look into SMP to darken it. That should help a lot...IF IT IS DONE RIGHT!!!

Wwizz You have that exactly right. The punch scores down about half way down, sometimes a bit more, and then stopped. Then the perforating needles continue down into the fat. The way I designed it you slde down a ring containing 4 perforation spikes, then pull it up, rotate it a few degrees, then send it down again for more perforating. Then you grab the graft (compression unfortunately) and pull. The surrounding tissue will tear away before significant tension can be placed on the body of the follicle. But you don't need the apparatus. You can just take one needle, hold the graft under mild to moderate tension, and then slide the needle down and blindly poke down. After about two or three pokes the graft comes free with far less damage. The reason you don't see this technique being used in any of the automated "high tech" systems is because I patented it. Actually, two patents on the system. They knew not to touch it. I'll dig up video of this and post it.

Joe, excellent lecture. I couldn't agree more with you. Strip first and then FUE. Blake, kudos to you for your diagrams and explanation. But I want to clarify something that caught my eye and that of Swoop's as well and that's the change in the donor area after massive FUE. It is true that the angles of the follicles will change, but that really isn't the problem because a skilled FUE practitioner can change his angles easily, just like a billiards player. The problem is WHY the angles changed and lost their uniformity. The reason is that the dermis has been undermined and infiltrated by fibrosis. Whereas before the FUE procedure the dermis was hardy and flexible, thereafter it becomes brittle and stiff and extremely vulnerable to the three detrimental forces unique to FUE: Torsion, Compression, and Traction. When performing FUE a skilled practitioner relies on the resistance of the skin itself to control the application of the punch. But after fibrosis, the characteristics of the donor skin change radically and the skin loses much of it's resistance. The result is Follicular Collapse during an extraction attempt. When the punch is applied, the brittle skin gives way and the punch slams down uncontrollably causing a transection. It's like termites eating the floor. It looks fine, but look out when you take that first step. But even before this can happen, the TORSION force of the punch may have already literally broken the target graft in half for the same reason. That being the skins integrity has been undermined by fibrosis. So when the punch was pushed down over the target graft it forms a seal with the wall of the punch and turns with the punch as one. Since the base of the graft is still attached lower down, only the top twists and SNAP, the graft is in half. Sometimes the center of the graft keeps the graft intact while the outside circumference of the graft had transected. Like a big surface crack wrapping itself around the graft. That graft is toast. And the chances of all of this increase directly with the number of FUE attempts made to get those grafts out. That's why I oppose megasession FUE cases or multiple sessions of FUE.

Perhaps, John. But I wouldn't be surprised by the tremendous amount of scarring and fibrosis within your donor area which would hamper future procedures and yields. You also make my point for me, which is that you inevitably compare FUE to FUT. It has been 14 years since its introduction and FUE still can't stand on it's own but rather still has to compare itself to FUT. If you read the first post of this thread it's that FUT is more popular than FUE. Not that FUE should be hammered. In fact few HT procedures worldwide are of the FUE variety. They are FUT. But since FUT is so well established it doesn't get the press it used to anymore. It's like solar power. You hear about it's wonders all the time and how it compares to gas/coal powered generation of electricity. But do you ever read about how great gas/coal powered generation plants are at producing electricity? Never. In fact, they are derided all the time as terrible for the environment and a blight. Yet it is STILL the standard that we all rely on. Like FUT it is the unsung bedrock of electrical production; yet it is solar panels that get all of the press and the admiration from the masses. It is wishful thinking that makes this happen, along with a disdain for the conventional. Same thing for the FUT vs FUE debate. You can have your solar panels, I'll take a generator. You wrote that I hammered FUE. I didn't. Read what I wrote again. I merely exposed aspects of FUE that were clearly being ignored, denied, or suppressed by those who do not perform them. I am not anti FUE, it has it's place and I perform them regularly. I just disagree with large numbers of FUE. Strip is simply better and safer. John, you wrote in your post that I would be surprised NOT to find a linear scar on your head. Why would I or anyone else look unless you went out of your way to show us? You have plenty of donor hair with which to cover any scar, so who cares? By the way, you have massive scarring which I would see if I examined you, it just wouldn't be linear in nature. And the chances of an FUE megassion producing visible donor thinning is much higher than that for strip simply due to the shockloss factor. With thousands of hits this topic can't fairly be called a rant, but rather an eye opener and revelation for many. Rants don't produce this amount of interest from so many. You and your doctor included.

There you have it. My concerns embodied in actuality. London, I'm off this week, but will view your photos when I get back to the office on Tuesday and really pour over them. I'll PM you then. Best.

I agree, Magnum. If you cut away all the personal attacks and wishful thinking it comes down to the best approach being FUT followed by FUE (or mFUE) for the most efficient use of donor resources. Notice that even after thousands of hits not a single doctor has come on here to dispute these statements in fact? And after literally thousands of hits in a week you can be sure this thread has been read by most or all of the major players. It's making the rounds. But as I've offered in the past, if anyone THINKS their favorite doctor would dispute the claims made here, I am happy to make a three way phone call to that doctor, record the discussion with their permission, and then post it right here online. All I ask is that the person reveal their name and address so that they can ever more be held accountable for their actions in the light of day as I and my colleagues are. To date: no takers.

Swooping, I viewed the youtube link you put up and it does not support your statements. Spencer's view is to favor a HYBRID approach and states clearly that FUE just can't hit the sweat spots of the donor area like strip can. He is correct. If a patient needs a small case when he is young then he would recommend an FUE. I also agree-as long as that case doesn't exceed about 600 grafts so that they can be spread out far enough apart in the donor area as to minimize fibrosis and donor exhaustion. But for megasessions, which is the OVERWHELMING majority of HTs performed in the modern age he still advocates FUT. And rightly so.

Paddy, You obviously have not been personally and professionally attacked by this person. I have. He is exactly the reason why other doctors will not post on these chat forums. Him specifically, among others. This is not my opinion, this is absolute fact. And he knows it. He believes himself to be a consumer advocate and expert. He is none of these things. Who would you rather hear from: uninformed anonymous guys like him, or doctors who have specialized in HT for years? Even better, doctors with different viewpoints. That's how it used to be on this site before the likes of him showed up. Most of the doctors just tuned out. And who losses? Patients do! You do. Truth is, it's the responsibility of physicians who support this site to set the record straight when it becomes so distorted by people like this. But they won't because they don't want to be personally attacked. To my mind, people become more civil when they know they will stand accountable for their actions. That's why I ask guys like him to reveal themselves. And NONE of them do. Who trusts what a shady person writes? I stand in full view of the world with my personal and professional reputation on the line each time I post, so you can bet it is sincere and supportable. I have no agenda other than to put my best foot forward and deliver the best information that I can.

Here are photos of the invention we spoke about Wwizz. The patent issued in 2007, but I applied for it years before. The suction part is pretty self evident. However, the perforation part is a bit more complicated. You will see the little spikes that slide up and down the punch. So the doctor scores around with the punch in the usual fashion and then sends the spikes down deeper into the skin to perforate around the target graft much as in the video above with the plastic. When traction is applied the graft tears free with much less traction and damage. I demonstrated this to Dr. Walter Unger when I showed him his first live FUE transplant in my office. That's why he put me in the 4th edition of his textbook.

Ontop: That's good thinking but it has been tried by several doctors with no practical results. The problem with that approach is that it takes an awful lot of time to get the grafts out. Also, it included the introduction of a long and fairly wide tool, like say pencil size, being slid under the scalp in the deeper layers. This can introduce a massive infection under the skin that can actually turn into a deadly bone infection. I wouldn't mess with it. Really deep thinking though. Isn't that more fun than counting sheep? When I go to bed I'm always trying to imagine new ways to do things. Wwizz, I will post the patent illustration on this topic in a little bit. Love to get your input thereafter; yours as well Ontop if you care to.

HairJo, I had similar teachers and professors who did the same thing. They weren't the most popular, but they were respected as no nonsense guys. It's not a popularity contest. Same thing here. When I post I'm giving a lecture about how it is. It's called educating. I am a qualified and certified expert to do it. I do it in the light with my real name, reputation, and professional license on the line. Anyone may attend if they wish and ask questions at the end. If you don't agree with the lecture or the lecturer a civilized person just gets up and walks out. But on here the FUE chest thumpers crash the hall and try to take it over. When they are resisted with cold hard facts and a doctor who won't be intimidated they get even more angry and stoop to slinging mud. Then they claim I'm being unprofessional and attacking them. It's laughable, especially considering it's my topic. Social media like this chat forum are becoming more and more influential in people's decision making. It is the therefore the responsibility of experts to set the record straight even if it means taking some personal attacks from anonymous posters. Tell you what chest thumpers, I'll stay off of your topics (I've never been onto a single one to date) and you stay off of my topics. That should be fair enough.

Bill, I agree with your philosophy that FUT and FUE should coexist to maximize donor usefulness. That is my view and it makes the most sense by far. However, I disagree that FUE has improved tremendously, or at all. In fact it is the same exact procedure it was when it rolled out in 2001 in the U.S. The only change is the number of people performing them and the amount of time that doctors/patients are willing to spend to get any number of grafts out. But as sure as the keyboard you type on has not changed in 14 years, neither has FUE. This is my point and one of the fallacies I'm trying to address that vicious posters like Mickey, Scar5, Hairweare, Sethicles, Kaiser Soze, etc... are trying to obscure, block, and deny. Of all the chatter on the boards about FUE nothing, but nothing is more important than establishing that there have been no advancements in the way FUE is performed. Absolutely NONE! Has even a single FUE doctor said (and proved) anything in public? Nope.The answer is NO. The technology is EXACTLY the same. Mav, I appreciate your kind words but do not understand the hesitations you mentioned. I couldn't care less what the attitude of my surgeon was if I felt he was one of the best. In the regular medical world you'll find most surgeon's have a very real off putting attitude. But in the OR that's the guy you want. Any number of doctors will back up that truth. But you don't know me. All you know is what I write online, some of which is to defend myself. If you wanted to know if I"m off putting in real life, you should have visited for a consultation. Then you could have written about it online. I have no worries about it. The internet is a far more uncivilized place than the real world, and I believe that if the identity of the more nasty posters were known they would act more as they would in real life. And I'm about keeping it as close to real life as possible.

Mickey, Why such hate? So brave hiding behind a keyboard. So loud, too. Tell you what, since your only reference to reality is invoking the name of my friends and colleagues without their knowledge or permission, let's call any one or ALL of them together and see what they say about your claims about me and FUE in general. I'll record it with their permission and post it online for the world to hear. We can also call your FUT surgeon as well, he's a friend of mine also, but I won't reveal his name. Just PM me your real verifiable name and address and we can have at it. Mickey is simply an online bully and stalker. Also known in the parlance of the internet as a "Hater". He doesn't hate everybody, just those who disagree with him. Sorry Mickey, but doctors are allowed to use this website and share their opinion unmolested by the likes of self appointed know nothing "experts" like yourself. I don't come on here to debate with the likes of you, although you hilariously think I do. I write to bring facts to newbies who don't know any better and might be influenced by you and your kind. If you fancy yourself a consumer affairs expert and want to hold yourself out to the public as such, then stand accountable for your words and offer your real name and address.

Wwizzz, Great thinking. I truly mean that. Few people can imagine what you just did, so I am VERY impressed. You are inventive. And that's just a thought you had in the morning?! You may have quite a gift. Actually, I received a patent on exactly what you are talking about. I'll post it later. There were some problems with it, however. But I would seriously like to talk with you because if you can come up with that apparatus without performing the procedures first hand you have the kind of mind I like to know. PM me if you are interested in throwing any other ideas around. If nothing else it is an excellent mental exercise. Dr. Feller

Seth, if you stopped posting the mud slinging would stop. You and the others like you are the only ones doing it. How strange you should write that. But if such an app were written and converted to numbers here's what would happen: Best chance for growth: Strip= 4 FUE=2 Least damage to donor area Strip= 4 FUE=1 Least obvious scaring in donor area with hair grown Strip=4 FUE=3 Least obvious scarring in donor area with hair shaved or buzzed short Strip=1 FUE=4 Best potential graft availability in future Strip 4 FUE=2 Totals Strip= 17 FUE= 12 The app would pick FUT. The only way FUE could fair better, but still not beat FUT was if a much greater weight were put on scar appearance, and this would be based on pure personal desire. FUE was already given an advantage of 4 to Strip's value of 1, but even if it was given more weight it still couldn't beat out strip. The other factors are not subjective and therefore can't change. FUT wins hands down, even with FUE being given a handicap.

Sparky, I've always wrestled with how much surgery to show publicly but usual decide to show more than less. Availability of surgical information is pretty wide spread thanks to the internet so most people are becoming desensitized. However, I still think showing the strip portion may be a bit much. Showing the area with the surgical staples or stitches is fair play though. I just looked at your profile page and see you had multiple strip procedures that didn't work out. I"m sorry to read that. It is all too common. When you started you rarely saw a procedure that even reached a 1000 grafts in one procedure, so they did you piecemeal. Each time you surgically go back into an area it gets more and more "insulted" and more and more scarred. I didn't see your results, though. Did you post them? I'd like to see how it looks after all that work if you feel so inclined. Thank you for joining the topic.

BUSA wrote: "Look at this forum and lets count the number of FUE procedures vs. FUT. it wud not even be close. far more chose FUE these days that post up here and the ppl that post up here for the most part have done their research and made informed decisions." This is simply untrue. There are some FUE posts on here, but most are either negative by the patient's themselves, or incomplete. There are a few great ones which is why I believe FUE has it's place, but their number is a drop in the drop of the bucket compared to it's FUT counterpart. BUSA, you do not speak for me nor know what my motivations are, so please don't assume to invent them and post them on here as if they were facts. If you wish to do that, send me your real name and address and I'll be sure you get all the credit you deserve. FUT- only doctors have little to worry about as there are so relatively few FUE doctors out there to begin with, and even fewer gifted/dedicated ones. The FUE "mills" turning up in Europe will not last. FUT and FUE practitioners such as myself have absolutely nothing to worry about because we can do either procedure. If the world outlawed one or the other surgery tomorrow I'll still be sitting pretty. FUE-ONLY doctor's have nothing to worry about because there will always be a subset of patients who will want their services. And since there are so relatively few FUE only doctors in then world there will be plenty of patients for them. The only time for any hair transplant doctor to worry is when people stop caring about their hair loss.

Bad hair day for sure. We didn't plan that video or rehearse it at all. We just did it and it fell into place. I had been moving some stuff around the office just prior and my hair got messed up. But at least I have hair with which to have a "bad hair day". Not bad for a stage 6, eh?! The force I used to snap that plastic is proportionate to that used during some FUE extractions. While I obviously don't have to pull that hard, the tissue is likewise not nearly as strong. So in the end I doubt this demonstration is far off from reality. I did't even realize until we were shooting the video that you could actually see the lines of traction developing throughout the plastic pseudo follicle. It was quite telling. That's when I had the idea to draw two follicles on the plastic and see what would happen. Pretty devistating and likely explains most of the disparity in yield between strip and FUE. My perforation method helps, but obviously not as good as mFUE technique. There are some FUE patients in whom the grafts come out with almost no fight. But some are so bad there is no way to avoid tearing the follicle literally in half as you saw in this demonstration. Thank you for the comment, and you to "Ontop".

A demonstration as to how FUE causes traction damage to the grafts and a few suggestions on how to minimize it, or avoid it completely. Dr. Blake Bloxham Dr. Alan Feller Great Neck, NY 516-487-3797

LondonHTseeker, Thank you for the kind words, I truly appreciate it. Since only Dr Bloxham, Dr Lindsey, and myself are the only known mFUE surgeons in the world it may be a while before a European doctor becomes proficient at it. So, I'll tell you what, why don't you visit here for your mFUE procedure and we'll perform it for free. All I ask is your permission to post it online for the world to see as it happens. We will hide your identity of course. Please send to the info@fellermedical.com mailbox detailed photos of your target recipient area and donor area (wet and dry). That would be very helpful. If I believe there is enough to work with, then we have the green light. Best, Dr. Feller

All the typical hyperbole, but some posts stand out: Spanker, you are dead on correct. I agree with you. Strip until you can't anymore, THEN go FUE. To get this, patients can go to a doctor who routinely does both like I do, or Dr. Feriduni, Dr. Bisanga, etc... . All excellent. Or, go to a great strip doctor first then go to an FUE only doctor like Dr. Lorenzo. What could possibly be wrong with that plan? I think it makes the most sense. I would not and have not had FUE performed on me for a reason. Doesn't that speak volumes? Irish, thank you for telling it like it is and participating. I think the attacks on me and FUT are getting old. If anyone has any actual questions about this topic please ask them so that others who aren't so cocksure of which way they want to go, FUT or FUE, can learn a thing or two from BOTH sides.

Blake, I have no idea what he's talking about either. He seems to be referring to me having said in one post that I would recommend 8 months before having a second HT and then in a second post saying I would recommend 6 months before having a second HT. And somehow that is a grand contradictory statement. In reality I may recommend anywhere from 6 months to 10 months for a second HT depending on certain variables. Why someone would harp on such minutia and post it on here as a "gotcha!" is beyond me.

First, let me tell you that motorized punches really don't make the procedure easier, just faster, but at the cost of yield. And this if from a doctor who actually produced a commercial motorized FUE hand tool used on the market. But mine was truly unique and included novel features. The others are just drills. And still I decline to use it on most patients. My hand is better. I can't speak for why others charge what they do. It is not my place. If their price structure works for them, then bless them. I happen to like and respect all the doctors in your list by they way.