Dr. Alan Feller

Charlie, I believe 600 grafts will do exactly nothing for you. I would suggest 3,000 grafts in the front half of the crown alone. When I get to the office tomorrow I'll post a similar patient on whom I did just that. Dr. F

Charlie, The reason you don't have a cornrow look is because your yield was very poor and the caliber of the surviving grafts was thin. Ironically, had your yield been better, the unnatural distribution of your hair would have been far more noticable upon casual inspection. You were lucky. What you have to understand is that for every area of skin there is a critical number of grafts required to obtain a cosmetically signficiant improvement. For the life of me I cannot understand the logic behind the approach to your procedure. I have seen nothing like it either in textbooks or on the internet. Again, I think you were very lucky you had a poor showing from that transplant.

Lara, Please identify yourself to me privately so I can investigate your claims. Private mail me through this site. Dr. Feller

Don't get out the med school application quite yet Tofueornottofue. My last real vacation was in 2003.

Sounds good Ben. See you in August. Dr. F

I just came back from a much needed vacation and have not looked at a computer screen or surgical instrument for almost 2 weeks. Probably the most rest my eyes have had for some time. I see that while I was gone a non-surgical hair transplant "issue" concerning my office has been raised. Many thanks to those pateints of mine and other reputable posters who gave their time chiming in. I'm actually shocked that this "issue" created 3 pages of "traction". Lara, I honestly don't know who you are. You will pardon me if the information on my side does not match what you have written as an anonymous poster: 1. I have talked with Marcia and no patient has called repeatedly with any questions for me. 2. You claimed on this thread to have private mailed me. However, I have checked my private mail and have no messages from you. I have asked Bill to check the HTN PM log to confirm this. 3. I have had no recent cancellations of surgery by any patient within 3 weeks of their scheduled procedure. 4. I have had no chargeback notifications from any credit card company. 5. All deposits are non-refundable. It says it on my website and is repeated to the patient at the time the deposit is submitted. Even so, in my 15 years of fulltime practice I've never denied a patient a refund if the cancellation is as far out as 3 weeks. Lara, at this point I don't believe you are who you say you are. Your post is way to harsh, aggressive, and over-the-top. None of the facts I have support your claims which to me seem designed to materially hurt my reputation and do damage to my business. If you are real, please submit your full name and date of your procedure to my private mail box here on HTN. Or just call the office and leave that information with Marcia. I believe Spex has already asked you to do this and to date has not received your response.

7 months from second session

7 months from 2nd session

Photos from Britsh patient "BadhairUK" 7 months from second session Pics taken outdoors.

I don't know about your SPECIFIC case, but on average you would have another 40% to go from your 7th to 14th month. What I mean by 40% increase does not necessarily mean a 40% increase in the number of hairs, but rather the overall cosmetic look of the result. So, whatever look you have by 6 months should roughly appear to be twice as thick by 14 months. In most cases this is largely due to the increasing caliber of the hairs and not new hairs waking up. Keep posting and throw us a few pics when you get the chance. Best of luck and grow well and strong. Dr. F

What you are describing is expected at the 7 month stage and you will begin to see the hairs "normalizing" over the next few months. You can look at each individual follicle like a flower vase where the inside of the vase is lined with cells. Each of these cells secretes "liquid hair" into the center of the vase where enzymes work on this material to form and extrude a new hair. The reason you see fine hair is because the cells are not secreting as much liquid "pre-hair" as they ultimately will. The reason you see the kinky hair is because some cells wake up and start producing liquid hair before other cells do. The distribution is such that there is an uneven contribution to the final hair which means one side of the hair shaft will be thicker than the other side. The result is a bend or "kink" in the hair. As the cells in the follicle wake up a more even distribution is re-established and the hair goes back to looking as it once did in the donor area. This is what happens in the overwhelming majority of patients. HOWEVER, variations do occur. In some patients the kink may become reduced, but never go away. In other patients the hair may never come out of the "fine" stage. That is, only a few of the cells in the follicle ever wake up and come online again. If the surgeon in whose patient this occurs has a good and consistent track record, then it's a safe bet to say that when this occurs in the rare patient it is due to unpredictable physiological limitations. If however the surgeon and tech team are inexperienced or demonstrate an inconsistent track record then the chances are higher that it was mishandling of the grafts at just about any point during the surgery. That's why sites like this one were created-for potential HT pateints to see evidence of consistent track records and to get detailed answers that they would probably never find elsewhere. Dr. Feller

Hairthere is correct. Looks more like a 300-500 graft job.

Thanks Ben, From your blog I can see where you want to flatten the hairline. We'll pack it nice and tight in the corners for you. No problem. See you in a few weeks. I'll take alot of pics for your blog. Grow well, Dr. F

Really great blog Ben. I'll send you the photos and video I took of you in Virginia over the winter. Grow well, Dr. Feller

I agree. Looks like good solid work to me as well. Best of luck. Keep posting. Dr. Feller

Ben, I saw your hair blog- really good. I hadn't seen all the work you put into it. It really tells the story. The photo with the turkey cracked us up. I'll send you the photos I took of you in Virginia and the video when I get the chance. It will be a nice addition to your blog. You really look great. Congratulations. Dr. Feller

Thana, Looks like you are a bit ahead of the curve in as far as growth goes. Most patients will not look as thick as you by six months. You look great though, and as others have already written you have more to go. Technically speaking you are only at the half way mark. You will also note the kinky hairs beginning to smooth out over the next 4 months. Thana had incredibly good hair characteristics and he is in excellent physical shape as he is a competeing athlete. I think all of this added up to his excellent result at only six months. Continue to grow well and post your experience and photos as you do so well. Balody, We may have our differences, but I must say your post cracked us all up here at the office. We pull out the dictionary when thana posts and it's been a running chuckle for us since he first posted. Dr. F

Josh (sofarsogood), It's obvious that you are happy with your FUE procedure and support your doctor. That's good, but there are undeniable issues with FUE that you should consider before pitching strip surgery overboard. On paper FUE seems like a viable alternative to strip surgery, but the past 6 years have proved otherwise. The number one problem with FUE is growth yield. It is simply lower than that of strip. The reason for this is an obvious one. The level of trauma FUE grafts experience is much higher than for strip grafts. There are three detrimental FUE forces: 1. Torsion 2. Traction 3. Compression No matter who performs the FUE procedure and no matter what instrumentation is utilized, there three forces are always working AGAINST the FUE doctor and patient. When these forces are minimized or eliminated, then FUE will be on par with strip. To date, no one has produced such tools or techniques nor expressely claimed to do so. Perhaps someday, but not today. Again, on paper it seems that FUE will allow for a significantly broader harvest of hair such as hair outside the "safe zones" and even body hair. But bodyhair in general has proved to offer, at best, mild improvements. And that's after massive effort and cost. It is not, nor has it yet been shown,to be any kind of alternative to scalp hair. Nape of the neck hair really should not be harvested. Again, on paper it seems like a good idea, but on closer inspection it really is unadvisable. Nape hair is thin because the body PURPOSEFULLY weakened it. As a weakened follicle it will not, and does not, transplant and grow well. It is the same problem with body hair. Strip doctors don't harvest from the nape because they can't, or because it will leave a nasty scar (it will), but because the hair itself is general not recommended for transplant. There are some people with VERY thick nape hair and it is THESE exceptions that make FUE a superior technique over strip. However, such patients tend to have wonderful donor area and so invasion of the nape is rarely required. FUE is a great procedure, but it is still a limited one. As a practitioner of both procedures I still believe FUE is not ready for "prime time" in anyones hands to date. When FUE doctors show a regular flow of mega-FUE/BHT results that are on par with strip surgery, then and only then will we know that this procedure has "arrived". But as long as FUE proponents wrongfully villify strip and their practitioners as a means to advance their cause, they will only erode the little credibility FUE has gained over the years and confuse the public. Dr. Feller

Homeslice, We don't do anything because it is easier for the doctor and staff. We shave hair because it clears the field to allow for better visualization of all structures and allows for a denser pack. Staples may be quicker than sutures, but they are certainly not easier to use. It takes greater skill to be able to use a staple gun to approximate two uneven edges of skin as compared to suturing. However, the extra effort and expense (staples cost 5 times more than sutures) seem to be worth it. Sometimes recipient areas need to be shaved, sometimes they don't. Sometimes you don't know until surgery depending on bleeding and clotting. In most cases I advise that the hair be shaved much in the same way that any thing you work on should be well illuminated and free of obstruction and hindrance. After all, the hair will grow back. In the end, all of the above takes a backseat to results. Check to see who has the best and most consistent results and then look backward to how the procedure was done. There are plenty of great doctors out there, just do a bit of research. Thankfully the web makes it much easier than ever. Best of luck, Dr. Feller

Dr. Epstein, 1. I believe the direction of natural hair growth is best determined when the hair is cut to stubble length, not when left long. When cut short the direction of the hair is exactly in line with its associated follicle. When left long the actual angle may easily be distorted depending on which way the hair is combed. Other problems associated with leaving the hair long during HT is that it will always unnecessarily increase the overall surgery time and place more stress on all the tissues and anatomic structures involved. Finally, it taxes the doctor and staff far more than is necessary because the visual field is often totally obscured and must be constantly combed and manipulated to simply see the skin. Leaving hair long during an HT is like trying to read a newspaper below a glass bowl of spaghetti with marinara sauce spread over it. An unnecessary hindrance. 2. Isn't it easier to simply outline the areas that need more attention with a surgical marker BEFORE surgery rather than to work in a tangle of blood-clumped hair? 3. There is no question that patients prefer having their own hairs so they are presentable. But at the expense of the final result which brought them to an HT clinic in the first place? Dr. Mejia, We do not use multi-bladed knives of any kind in our practice. In 2003 I asked Roy Ratson of Cutting Edge Surgical, Inc. to produce a multi-blade prototype for me. He built one out of aluminum stock and sent it to me which I used in a few cases. Personally, I found it was of little advantage when compared to my single blade holders and decided not to include it in my practice. I know he still sells the unit, but I know of no doctor who uses them regularly. For what it's worth, the only application for which I asked Mr. Ratson to build such a tool was for areas of scalp on certain patients that were completely devoid of terminal hairs. It was never to be used in hair bearing areas of recipient scalp. I still have the prototype device which I will snap a picture of and post on this thread next week. Also, as far as your patient Andy. You should understand that the amount of hair that would have to be cut in his case would be minimal. None of what is referred to as his "long hair" would be touched. The video clearly shows baldness and miniaturization of the frontal third of his scalp. Most of what would be cut there would be completely grown back in 3 months, not years. And the cosmetic difference would be negligible. If you view the link below, you will see before/after pictures of a patient of mine who also had "rocker" long hair. I did not have to cut any of his cosmetically significant hair to achieve the look he and your patient Andy were after. Only the miniturized hairs in the target recipient area were shaved: "Rocker" long hair paitent who didn't need to cut his long hair to pack the bald area in the front Do you have any intraoperative photos of Andy or post operative photos? They would be helpful if you post them as we can compare them to the density offered by shaving hair down in the recipient area prior to surgery. Perhaps you and Dr. Epstein are confusing the phrase "cutting or shaving hair" as meaning the ENTIRE head and not just the target areas? I look forward to the Andy photos. Best of luck, Dr. Feller

The article you are referring to is testiment to the enduring power of the negative publicity that the old syle plug work and its practitioners inflicted on this industry. Even though that procedure has become almost completely extinct the term "hair plugs" is still the standard vernacular used by uninformed non-hairloss sufferers. When they choose to use the term only some writers are innocently unaware that its use is not only an inaccurate one, but a pejorative one as well. Other writers knowingly use the inaccurate term "hair plugs" because they know it will get a rise out of readers. Afterall , what is more eye catching and gut provoking-"Hair Plugs" or " Follicular Units"? When you see the term "Hair Plugs" you instantly think of a train wreck and want to see pictures of the victim. But when the term "Follicular Unit" is read by the causal reader they move on and chalk the term up to "techno-speak" that isn't worth the energy to investigate. Remember, in the media "if it bleeds it leads" and bad news is the only real news that sells. "Feel good stories" are only used to fill slow news days. The use of the word "plugs" is inaccuate, pejorative, and wrong. But guess what...the media doesn't care. Just ask ANY publication or media outlet that ever ran a feel good story on Low Light Laser Therapy. Not once have they seen any actual results, but that never stopped them from publishing an article about it and then accepting advertising dollars from manufactures of such useless gizmos and quackary. Dr. Feller

This is a very old debate that has run its course many many times. My position is that it is BEST to shave the hair down for many reasons already listed in several other discussions. I do not believe that in most cases maximum density can be achieved in a minimum amount of time without shaving- especially in megasession cases. Since you named this thread "Dr. Feller vs Dr. Epstein" you would be best served by simply plugging both our names into the search engine feature here on HTN (or any other site) and comparing the pictoral results of our patients and making a comparison. Since Dr. Epstein is not a proponent of cutting hair and I am, the differences in our results should give you the answer you are seeking. This is good advice for any patient seeking to select a doctor and is one of the main reasons for the existence and success of this community. Research is the key to the HT game. Most of the information you need is right at your fingertips. Best of luck, Dr. Feller

Dr. Umar is right. I should not be commenting on his thread. I will delete my comments and offer my apologies. Dr. Feller

Excuse me Bill, when did I state or imply that people are not entitled to disagree with me? Is this not a forum for debate and discussion and open speech? By asking me not to speak while you allow other anonymous posters to continue their rants and attacks is hardly fair. You should have locked the thread. Why have you let posters like Something and Hooray attack me with ad homonym attacks? Have you read their disgusting posts? You should have deleted their posts or suspended their accounts for such behavior but you didn't. Do you honestly think the nasty posts they wrote about me were in good faith and germane to the discussion? I would think that as a moderator you would have put a stop to that. Instead you let it ratchet up. This thread is about a very important topic. And as a member of this community, a paying member no less, I have been invited to speak out as is my right. Nothing I have said here was false, wrong, or untrue. What I said needed to be said and both you and Pat have endorsed it by deciding to rightfully hold off on recommendation. In fact, since I was the only voice of dissension I can only assume that your decision was based solely on my view points. Am I now to understand that everyone else on this thread should be allowed to continue stressing and supporting their own views but that I alone am to be censored and gagged? Especially when I am the only voice of dissension? If someone makes a post it is my understanding that it is everyone's right, including mine, to disagree. If chearleaders of FUE/BHT wish to continue edorsing their doctors, they should do it on another thread. This one is about a potential recommendation and any post written about such recommendation is open to retort. Isn't that what forums like this one are all about? This thread went off track not because I expressed my views, but because you allowed deviant behavior and posting on the part of a few posters who just can't handle opposition and participate in a discussion of differing opinions.

Dr. Carman, I must respectfully disagree. Demeanor, ethically-driven behavior, and being a class act are not the criteria for recommended status on HTN. A proven and demonstrated track record of top notch results is. That's the whole point behind the recommendation list in the first place. It's a place for newbies to see at a glance those doctors who have demonstrated consistent success on average patients like themselves. Sometimes stating the truth is unpopular and it obviously rubs many people the wrong way. The simple fact is that if you look at the very best results of any FUE/BHT doctor you will not find any results matching those of established recommended doctors like Dr. Shapiro, or Dr. Hasson, or Dr. Nakatsui, and many others. Shouldn't that be the first and only criteria for recommendation? It's not that Dr. Umar isn't professional or a nice guy. On the contrary, your glowing review after meeting him in person is good enough for me to conclude he is a gentleman. However, the results he demonstrates on this thread are simply not up to the level of other doctors because he chooses to utilize an inferior procedure. It is therefore not fair to either the other doctors who have achieved recommended status nor to the public to place such a practitioner on the list. Doesn't this make sense Dr. Carman?