Dr. Alan Feller

Gas, The unnecessary wasting of grafts is unethical no matter what the circumstances are. However, it appears that you, other uninformed patients like yourself, and many of my own colleagues don't seem to think wasting grafts is such a bad thing. Let me explain: When a doctor supposedly throws grafts into the trash because the patient won't pay for them, a claim that is most likely fictional, THAT'S wrong and unethical. However, When a doctor performs a megasession FUE which guarantees graft wastage, a claim that is absolutely true and verified, that's just fine. See the problem here ?

Thank you.

In the beginning, from 2002 to 2004 most were my own patients as there really was nobody else performing FUE of any kind of regular basis in America. The results were ok for smaller procedures like 500 grafts or so and thus FUE looked promising. But as the cases got larger in number, the growth deficiencies and unnecessary damage to the donor area became more and more apparent. I saw this early on and avoided large FUE sessions. Of course I performed them, up to 3000 grafts, but could see the results just could not compare to FUT. And the damage caused by these megasession procedures was unjustifiable. As others began to jump on the FUE bandwagon I began to see more and more of other doctors results and that's when I learned most growth rates were about 60% of the reported number for megasessions. And the reason for this became obvious rather quickly. I wrote about it extensively on this forum when HTN used the older format. The problem was that in order to increase the number of grafts the speed had to be increased. As speed increased, trauma to the graft increased as well. So the growth yields dropped. Of course I wanted to believe that those clinics who were offering megasession FUE early on just had better technique and instrumentation than I did. I WANTED to believe that because I could ultimately learn it or figure it out for myself. But the results online and in person didn't bear that out. Most megasession FUE patients were NOT happy as reported on the internet and in personal consultation. As disappointed patients visited me for repair or just my opinion on the growth it became clear that the reality was not matching the hype. I knew something was wrong and I knew why. But I could only speak for myself because back then no clinic would tell or show how they performed their FUE...except for me. The modus operandi back then was to NOT tell or show how the FUE procedure was performed and then CLAIM a new and innovative method was being employed for marketing reasons. All lies of course, but how could it be proven ? Then a well known Greek company of the time screwed up. They posted a video of their "advanced" FUE technique that they had been hyping for sometime. It was supposed to be a marketing video. But I was appalled when I saw the video. I knew then and there that all they were doing was working faster, not smarter. No new techniques and no new instrumentation. I wrote against it and was, of course, attacked by them for it. But the evidence was right there in the video. They condemned themselves, but by me pointing it out I gained a reputation as a truth teller. Why did the patients of other doctors come to see me? Because of two things: 1. The first was the internet chat forums were beginning to gain greater popularity allowing patients to find doctors who specialized exclusively in HT. FUE cases back then, as now, were performed by "part-timers" and their patients didn't yet know there were HT specialists they could have gone to. Internet forums like this one opened a whole new world of choice to them and I was one of the few doctors who: participated regularly online, had a good rep for FUT as well as a good rep for the newer FUE procedure. So naturally they sought me out when they were unhappy. They weren't going to get satisfaction from the part time doc who gave them their poor FUE surgery now were they ? Of course not. 2. I created a persona of blunt honesty online and this resonated with unhappy patients of other doctors. It still does to this day. A 15 year old study is just as valid today if nothing substantially has changed. And that IS the case with FUE. Nothing has changed since the time Rassman and Bernstein did the study. FUE is 100% the same. A punch is used to score around a graft, the graft is grasped with a forcepts, and then traction is applied to break it free. I created a new punch and technique to decrease the detimental forces associated with the FUE technique and must admit that they made almost no difference in the over all yield. Nobody has produced anything better yet to date. The limitations of FUE still all boil down to those detrimental forces inherent to the procedure. So the FOX test and the study are just as valid now as they were 15 years ago. As far as pricing. FUT in Europe used to be incredibly high. I suspect that's why so many traveled to the US for their hair transplant procedures from 1995 to about 2013. But the introduction of bargain basement FUE into Europe seems to be destroying the European HT industry in general and an attitude of "if you can't beat them, join them" is prevailing. So more and more European doctors are getting on the FUE bandwagon as a matter of survival. The quality of a cheap FUE is not on par with the quality of a well performed FUT, problem is however that European patients don't know that. They don't seek out the reality and the doctors are all too willing to allow patients to believe what they want as long as they sign up for a procedure in their clinic. ANY procedure. This isn't happening in America because the techniques employed by the most vocal European FUE hair mills are illegal. And rightfully so. Pull the kind of crap going on in Europe and an American doctor will lose his license through regulatory malpractice which is a far lower bar than legal malpractice.

You are welcome. This video gives a detailed answer to your first question: Your second and third question are too subjective so no way for me to answer. But 10,000 available grafts ?! That's a bit far out there.

Cobblestoning repair isn't in demand like it used to be because it usually takes larger grafts squeezed together to produce it. Even low end clinics use smaller grafts these days so you don't see much cobblestoning. To answer your question, there is a technique to reduce cobblestoning. Even manual FUE pales in comparison to FUT which is why all reputable FUT clinics who claim to also perform FUE hold on to their FUT techs. Good move. But you are right about the FUE machines, they are truly awful. Thank you for the kind words.

That's my point. You leave your donor area longer BY CHOICE for styling reasons. That length easily conceals an FUT scar, so there is no point in having FUE performed. And no matter how well you believe your FUE grafts grew, FUT grafts would have grown better with less sacrifice to your donor area. Talk about being able to comb transplanted hair backward look at this result from a recent patient who visited for follow up. The entire frontal third of his scalp was bald and in just ONE proper FUT procedure he can comb it backward as far as he wants. We included wet and dry hair results video.

The FUE cases I perform are smaller cases of a few hundred maximum for fill ins, repairs, and for patients who otherwise could not have FUT surgery. I posted many of them including video years ago but they get little notice because they are such small cases. Most of my FUE cases now are to remove parts of old plugs or minigrafts, usually on the hairline or in front of where the hairline ought to be, in preparation for a large FUT procedure. I have performed about 600 FUE cases but Dr. Bloxham insists I have done more. He may be right as I haven't kept a running score. If you include the use of FUE to remove old grafts and whittle down plugs on the hairline then you can put my number of FUE cases into the thousands. By the way, it is much more difficult to remove follicles from an implanted plug or minigraft so when doctors contact me on how to start learning FUE I tell them to offer this service for free (as I did). Patients love it and it builds great manual skill and confidence. I did hundreds of these for free in 2002 and 2003 before ever charging for an FUE session and use it regularly when performing FUT to "clean up" old misplaced plugs and minigrafts. Our mFUE procedure has been evolving over the past three years and we have seen enough results to settle on a final protocol that we are writing up now. Interestingly, Dr. Paul Rose of Florida just published an article that arrives at the same conclusion we did about donor area usage independent of us and from a completely different point of view. It was so exciting to read how his paper supported our findings that I called him and he was just as excited that our independent findings matched his. It's a bit much to get into the details now but we will make a video with Dr. Rose that details what we found and why. The bottom line is that FUE is too injurious to the donor area and an alternative like mFUE may well be the solution to the problem.

I came to this number two ways: The first is clinical experience. I have seen hundreds of FUE patients in person and only about 15% demonstrated results that were comparable to FUT for the number of grafts they reported they received. The second is from Rassman and Bernstein's paper on FOX testing. A study that has conveniently been forgotten by FUE adherents. In the study only 26% of patients produced grafts that APPEARED to be as intact as FUT grafts (53 out of 200 patients). The other 74% produced grafts with varying levels of visible damage and difficulty in removal. Obviously damaged grafts will not likely grow as well as FUT grafts which are all undamaged- which means, by comparison, only 26% of FUE patients can have an expectation of growth on par with FUT. So now we are at 26%. So how did I get down to 15% ? The Fox test study only evaluated for VISIBLE injury. It did not test for graft viability. Since the publication of that paper it has become clear that even perfect LOOKING FUE grafts may not grow well or not at all. If you factor in a growth rate of about 60%, a number I base on clinical observation and my own surgical observation of hundreds of FUE patients, for healthy appearing FUE grafts just after extraction you get about 15-19% .

Yaz, When you stop acting like a child I will address you again. 911 It seems there is a battle for the survival of HT clinics in Europe. I imagine this is due to the cheap FUE being offered by nearby third world countries. So, in the words of Dr. Bloxham, there is a race to the bottom in Europe. I have a question, if the price for FUT in Europe has dropped so low, I wonder how many trained staff each clinic is now employing to properly perform FUT compared to 2010 ? I'll bet fewer. In fact, the Ishrs just sent out a questionaire to over 1,000 physician members and I suggested that very question be included. Should be interesting.

Yaz, Your story is a classic FUE cautionary tale. If you didn't want your story and your photos to be discussed then you should not have injected them into this topic. This is why I don't like to comment on specific cases. Feelings always get hurt and that's not at all what i'm after.

Yaz- When someone has to descend to personal attacks and foul language you have lost the argument. Your potty mouth has been reported.

To those who have read the exchange between me and Yaz and me and Hairlosscpa I would like to share my deep felt belief based on 24 years experience and thousands upon thousands of consultations with patients. When you have done something every business day for that long you begin to get a feel for people and the real reasons why they do what they do. I believe both these patients chose FUE not because they couldn't accept the thought of a concealed linear scar under the hair within the donor area after the surgery, but because they couldn't tolerate the thought of the actual surgical procedure where a strip of scalp is removed from the donor area. They were afraid of it. Simple as that. I don't mean this pejoratively, it just is what it is. I know some patients cannot overcome irrational fears of surgery. And while I personally believe this is a valid reason to choose an inferior surgery like FUE in the case of elective surgery, it is misleading to claim the choice was made for something as mundane and concealable as the production of a linear scar. All the more irrational when you understand that large FUE surgeries cause far more donor damage and scarring that prevent FUE patients from shaving their heads as claimed falsely by nearly every proponent of FUE. In both these cases: Yaz and Hairlosscpa claimed they wanted FUE so they could shave their hair. But neither of them does. Yet, irrationally, they BOTH state they CAN shave their head, but show photos with hair grown out in the donor area that would easily conceal FUT scars. Even bad ones. So this begs the question: why did these two patients opt for FUE ? The answer is simple and rather common for FUE recipients: they cannot bring themselves to have a proper FUT procedure performed out of fear of the actual surgery involved with strip. This is a VALID reason and nothing to be ashamed of. But when patients like these try to disparage FUT and trump it's so-called shortcomings as the reason I have to call them out. Both these patients could style their hair exactly as they do in their own recent photos, and even more revealing, had they received FUT surgery instead of FUE surgery.

I don't like to comment on specific cases because it could hurt that persons feelings, but since you are the one posting the photos and asking me specifically to comment then I will: First, it is disingenuous to use photos where the hair has been cut to different lengths. Obviously the reason you left the hair longer in todays photo was to cover the scars left by your old linear scar AND the FUE scars. Also Your donor hair is obviously thinner in todays pictures due to the classic damage and thinning large FUE cases typically cause. You have large patchy areas that are visible, particularly on your right side, despite the fact that you admittedly left the hair longer AND are on Propecia. So to answer your question I would prefer the FUT because: 1. I know the hair would grow better in the recipient site. 2. All of my hair would be from the safe zone. 3. I would have more hair in the donor area because less would have been injured or killed. 4. I would not have patchy thin areas in the donor. 5. I would be able to completely cover my donor scar If you had a proper FUT procedure for your second surgery you donor area would be thicker, you'd have more donor graft available for future use, and your scar would be just as invisible at the length you yourself prefer to cut your hair at. Please see the conversation I and Dr. Bloxham recently had with another FUE patient like yourself named Yaz. He made the same argument you are trying to make. He claimed there was no way an FUT surgery could have allowed him to enjoy his current hairstyle. Then we showed him not only was that not true, but the FUT would have allowed him to enjoy an even more revealing hairstyle, with less injury to the skin, less scarring, a greater chance for growth in the recipient area, and more grafts available in the future. The Yaz conversation starts at post number 18 in the following link. He too wasted his time on FUE when he could have gotten a better more reliable result with FUT AND had less donor scarring and more grafts available for the future. When he realized this he disappeared from the thread: http://www.hairrestorationnetwork.com/eve/186983-why-not-get-fue-interview-dr-willaim-reed-dr-feller-bloxham-2.html

And yet the only post operative donor photos I see in your links are with your hair long. Which begs the question: why bother with FUE ? I saw your linear scar and it looked good to me. You could have had your first scar removed in a second strip procedure and easily have had the option of a tight military fade buzz cut- and nobody would have been any the wiser.

"In Europe, strip clinics that do FUE are doing more FUE than strip because their FUE pricing is much lower and it is what people want. " I have no doubt this statement is dead on accurate. But it is also very revealing: 1. European clinics are doing more FUE not because it is better, but because European patients can't afford top of the line FUT surgery so they have to settle for FUE surgery- a much more unpredictable and unsuccessful procedure that can be done on the cheap. 2. The implication is that FUE is less expensive, but a better procedure. This is simply untrue on so many levels. It doesn't even make common sense.The only true part of this statement is that it requires far less of the clinic in terms of staffing, training, and physical plant. 3. Yet another more ominous implication is that technicians and other unlicensed/ untrained staff are performing surgery. A practice that is illegal in the US for a reason. I could tell you true to life horror stories about the way untrained low paid staff endanger patients. 4. The justification for offering and performing FUE surgery which flies in the face of over 20 years of hair transplant and general surgery dogma concerning graft/tissue handling is because "that's what people want". This is not an ethical nor acceptable reason to offer this adjunct procedure instead of the mainstream procedure. Hair Transplantation is surgery first, a business second. Most FUE patients in Europe, as in America, are people who would never have had a proper FUT procedure because they were afraid of the strip harvest; however, exclusive to Europe is the fact that FUE is actually cheaper than FUT and therefore people who could never afford a hair transplant now can. I would have no problem with this IF FUE were as good and reliable as FUT, but it isn't, and doctors are failing to inform patients of this. In Europe, this omission may be a matter of financial survival. In America it is grounds for revocation of medical licensure. And it should be. For a patient to go for FUE over FUT is to ignore logic and reality. It is an emotional choice that excludes reason. It's always the same false appeal " I don't want a linear scar". This is an absurd reason because it ignores the most important point of the surgery: that the hair should grow as thick as possible. If a person seriously wants to shave their head, then why get a hair transplant in the first place ? I have been performing hair transplantation for 24 years and patients seeking hair transplant surgery are not looking to shave their heads. That is a canard made up by uninformed patients and internet hype to mislead prospective patients into believing that FUE leaves them a "way out" if things don't go well. Take a look at the shaved head of a patient who had 3,000 FUE grafts taken then get back to me.

Really? Please show us where I said this.

Arminius, The difference in our views is that you only have your own singular HT experience to draw from and then write as if you can speak for the multitudes. This confuses patients and is no doubt part of the basis of the hype underlying FUE today. I personally have no doubt you are sincere, so please don't get me wrong. But you honestly and respectfully do not know what you are talking about because your access to actual hair transplant patients and surgery is severely limited. I literally have thousands of patient experiences and surgical experiences to draw from, and even more if you include patients who contact me online telling me about their very poor FUE results and asking if I can help them.. When I write what I do about FUE it's not to win points. It's to inform potential patients that FUE is simply not what it is claimed to be on the internet. Even you said that the yields are MARGINALLY lower than FUT. Yet I claim that you speak out of turn because, in truth, you have nothing to base that statement on. Have you ever seen an FUE result in the flesh ? And if you did, how many ? One. Two. Maybe three? Or is all your knowledge from internet forums and doctor websites ? Because both can be, and often are, misleading. Demonstrably so. And shame on my colleagues for that. Ask yourself this: if FUE results are only "marginally" less than that of FUT, then why does strip surgery still exist as the mainstream of hair transplant surgery ? If the difference were only marginal, every clinic would reject FUT for FUE. But haven't you noticed that absolutely no notable clinic who claims to do BOTH has rejected FUT ? Only about 15% of FUE patients will achieve growth results comparable to FUT. And that is at a price much higher than FUT surgery-and I don't necessarily just mean money. The damage to the donor area and the number of grafts destroyed during an FUE megasession is inexcusable and indefensible.

That's the problem. Patients such as yourself believe and want to believe that FUE procedures only result in MARGINALLY less growth. What a nonspecific and nice sounding word. The problem is, it's not true. Growth rates from FUE usually start at 75% that of FUT and go well down from there. That hardly counts as "marginal". Also, the amount of extra donor area damage and reduction in the number of grafts for future procedures due to that unnecessary donor damage is undeniable. I know you claim that you do not what a linear scar on the back of your head, but that's usually just a cover. Most people who don't want strip are simply afraid of the surgical strip harvest but don't want to admit it. So they claim that they hate the scar. It's nonesense. After all, the FUT scar is hidden under the hair and if done right can allow a person to fade cut their hair as many of my patients do. If a megasesssion FUE is performed you can't shave your hair down anymore than an FUT patient would, so what's the point ? One way or another it's going to look like something happened in the donor area, but the FUT patient has a greater chance of being able to cover it completely than the FUE patient because there is no significant donor thinning.

I can understand that for some people "the scar is a deal breaker". What I can't understand is how the poorer growth guaranteed with the FUE procedure is NOT a deal breaker.

This describes the situation quite well. Unfortunately, online misuse and abuse will continue unless something is done about it.And it is not practical to moderate every single post on a successful forum. I have a very simple suggestion. Software should be included in the forum that only allows an anonymous poster to mention any particular doctor's name a limited number of times. This would effectively limit "doctor bashing" as well as "doctor shilling". People are tired of both, and neither serve anybody. If a doctor is so "great" or so "awful", new posters will mention their name enough times individually to make a VALID impression on newbie viewers. No need for the same patient to be promoting their doctor over and over and over again for years. No matter how you cut it, that behavior is agenda driven and invalid. This would also limit the use of online reps by doctors thus compelling the doctors themselves to contribute on the forum in person. The more doctors who participate, the more valuable the forum and the information. I think it's time for a change and that's a pretty simple one.

Such is the nature of the internet.

Nah, you don't even know what my business practices are. We've never met nor ever done business together. And after 24 years of full time successful national and international practice, multiple clinics, thousands of patients and not a single lawsuit or litigation of any kind I think my business ethics and practices are pretty solid. You are just angry because you don't want to accept the truth about FUE. Hey, if you are so convinced of it's merits why bother to attack me? Just go ahead and get it done. You certainly don't need my approval.

I do plan on it. I will get as many doctors to share the truth as I can. An interesting thing to note is that the nasty anonymous posters who constantly attack me for posting the realities of FUE think that I am trying to convince them. I know these uncivil and irrational people will never be swayed. I post my writings and videos to counter the egregious hype and distortion created by these agenda driven laymen so that when patients who are truly interested in learning about hair transplantation will get all the true facts, not just the dishonest ones promoted by the likes of them.